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. 2020 Feb 13;20(1):54.
doi: 10.1186/s12883-020-01634-2.

Blood-brain barrier integrity of stroke patients presenting in an extended time window

Jarrhett Butler  1 , Parisa Heidari  1 , Sarah Blayney  1 , Emi Hitomi  1 , Marie Luby  1 , Richard Leigh  2
Affiliations

Blood-brain barrier integrity of stroke patients presenting in an extended time window

Jarrhett Butler et al. BMC Neurol. .

Abstract

Background: Current guidelines limit thrombolytic treatment of stroke to those patients who present within 4.5 h to minimize the risk of hemorrhagic complications. Risk of hemorrhage increases with increasing blood-brain barrier (BBB) disruption. This study aimed to determine, in a cohort of patients presenting outside of an IV-tPA treatment window, whether disruption of the BBB is time dependent, and what proportion of patients could be safely treated.

Methods: We analyzed untreated stroke patients, seen between 2011 and 2015, who had MRI studies in the time window of 4 to 24 h from symptoms onset. Permeability of the BBB was measured within the ischemic tissue using an application of dynamic susceptibility contrast imaging. Patients were dichotomized into two groups based on a 20% threshold of BBB disruption and compared using logistic regression.

Results: Of the 222 patients included in the final analysis, over half, 129 (58%), had preserved BBB integrity below the 20% threshold. There was no relationship between time imaged after symptom onset and the amount of BBB disruption (p = 0.138) across the population; BBB disruption varied widely.

Conclusions: Estimating BBB integrity may help to expand the treatment window for stroke patients by identifying those individuals for whom thrombolytic therapy can be considered.

Keywords: Blood-brain barrier; Extended time window; Permeability imaging; Stroke; Thrombolysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A flow chart details how the population included in the study was determined
Fig. 2
Fig. 2
A histogram shows how the mean permeability derangement was distributed across the population
Fig. 3
Fig. 3
Permeability imaging from six different patients is shown. Each panel has two thumbnail images and a larger permeability map. In each case, the upper thumbnail image is the time-to-peak (TTP) map and the lower thumbnail is the TTP map with the region of ischemia (relative TTP > 4 s) shaded in light blue. To the right of the thumbnails is the blood-brain permeability heat map within the regions of ischemia, color coded according to the color key at the bottom of the figure. The mean permeability derangement (MPD) is indicated in each panel for each patient. The three panels in the blue box on the left have MPD < 20%, whereas those in the purple box on the right have MPD > 20%. Panels a and b contrast two patients with large perfusion deficits, one below the threshold and one above. Similarly, panels c and d contrast two patients with more distal vessel occlusions. Panels E and F show two patients with an MPD very close to the threshold
Fig. 4
Fig. 4
A scatter plot compares mean permeability derangement with time from symptom discovery
See this image and copyright information in PMC

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