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(Stroke. 2007;38:1362.)
© 2007 American Heart Association, Inc.

Original Contributions

Hyperbaric Oxygen-Induced Attenuation of Hemorrhagic Transformation After Experimental Focal Transient Cerebral Ischemia

Zhiyong Qin, MD, PhD; Murat Karabiyikoglu, MD; Ya Hua, MD; Robert Silbergleit, MD; Yangdong He, MD; Richard F. Keep, PhD Guohua Xi, MD

From the Departments of Neurosurgery (Z.Q., M.K., Y. Hua, Y. He, R.F.K., G.X.), Physiology (R.F.K.), and Emergency Medicine (R.S.), University of Michigan, Ann Arbor, Mich.

Correspondence to Guohua Xi, MD, R5018 Biomedical Science Research Building, University of Michigan, 109 Zina Pitcher Place, Ann Arbor, MI 48109-2200. E-mail guohuaxi{at}umich.edu

Background and Purpose— An increased risk of hemorrhagic transformation is a major factor limiting the use of tissue plasminogen activator for stroke. Increased hemorrhagic transformation is also found in animals undergoing transient focal cerebral ischemia with hyperglycemia; this study examined whether hyperbaric oxygen (HBO) could reduce such hemorrhagic transformation in a rat model.

Methods— Rats received an injection of 50% glucose (6 mL/kg intraperitoneally) and had a middle cerebral artery occlusion 10 minutes later. Rats were treated with HBO (3 ATA for 1 hour) 30 minutes after middle cerebral artery occlusion. Control rats received normobaric room air. Rats underwent reperfusion 2 hours after middle cerebral artery occlusion. Blood–brain barrier permeability (Evans blue), hemorrhagic transformation (hemoglobin content), brain edema, infarct volume, and mortality were measured.

Results— HBO treatment reduced Evans blue leakage in the ipsilateral hemisphere (28.4±3.5 versus 71.8±13.1 µg/g in control group, P<0.01) 2 hours after reperfusion and hemorrhagic transformation (0.13±0.13 versus 0.31±0.28 mg hemoglobin in the control group, P<0.05) 22 hours later. Mortality was less in the HBO group (4% versus 27% in controls, P<0.05). Mean infarct volume and swelling in the caudate were also less in HBO-treated rats (P<0.05), but HBO failed to reduce brain water content in the ipsilateral hemisphere (P>0.05).

Conclusions— Early intraischemic HBO treatment reduces the blood–brain barrier disruption, hemorrhagic transformation, and mortality after focal cerebral ischemia suggesting that HBO could be used to reduce hemorrhagic conversion in patients with stroke.

Key Words: blood–brain barrier permeability • brain edema • cerebral ischemia • hemorrhagic transformation • hyperbaric oxygen

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