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(Stroke. 2009;40:454.)
© 2009 American Heart Association, Inc.

Original Contributions

Patterns and Predictors of Blood–Brain Barrier Permeability Derangements in Acute Ischemic Stroke

Oh Young Bang, MD, PhD; Jeffrey L. Saver, MD; Jeffry R. Alger, PhD; Samir H. Shah, MD; Brian H. Buck, MD; Sidney Starkman; Bruce Ovbiagele, MD; David S. Liebeskind, MD for the UCLA MRI Permeability Investigators

From the Department of Neurology (O.Y.B.), Samsung Medical Center, Sungkyunkwan University, South Korea; the Department of Neurology (O.Y.B., J.L.S., J.R.A., S.H.S., B.O., D.S.L.), UCLA Stroke Center, University of California, Los Angeles, Calif; the Division of Neurology, Department of Medicine (B.H.B.), University of Alberta, Alberta, Canada; and the Department of Emergency Medicine (S.S.), University of California, Los Angeles, Calif.

Correspondence to David S. Liebeskind, MD, UCLA Stroke Center, 710 Westwood Plaza, Los Angeles, CA 90095. E-mail davidliebeskind{at}yahoo.com

Background and Purpose— MRI permeability imaging is a promising approach to identify patients with acute ischemic stroke with an increased propensity for hemorrhagic transformation (HT). Permeability imaging provides direct visualization of blood–brain barrier derangements in ischemic fields.

Methods— We retrospectively analyzed clinical and MRI data on patients with acute cerebral ischemia within the middle cerebral artery territory to identify the frequency, patterns, and predictors of permeability derangements and their association with HT types.

Results— A total of 179 permeability scans was obtained in 127 patients (59 men; mean age, 66.8 years). Among 179 image sets (82 pre-/no treatment and 97 posttreatment), permeability derangements were present in 29 images, frequently at the basal ganglia (n=23) and rarely at the juxta-cortical area (n=6). After adjusting for covariates, diastolic pressure (OR, 1.12, per 1-mm Hg increase; 95% CI, 1.02 to 1.22) and s-glucose (OR, 1.04, per 1-mg/dL increase; 95% CI, 1.01 to 1.07) were independently associated with pretreatment permeability derangements, whereas low-density lipoprotein cholesterol (OR, 0.97, per 1-mg/dL increase; 95% CI, 0.94 to 0.99), malignant MRI profile (OR, 24.84; 95% CI, 1.50 to 412.93), and time from onset to recanalization therapy (OR, 1.47, per 1-hour increase; 95% CI, 1.10 to 1.96) were independently associated with permeability derangements after recanalization therapy. Types of HT varied among the patients with permeability derangements (no HT, 4; hemorrhagic infarct type, 12; and parenchymal hematoma, 13) and transient derangements (without subsequent HT) and normalization of derangements (in the presence of HT) on permeability images was observed in several cases.

Conclusions— Permeability derangements, a dynamic process associated with ischemic stroke pathophysiology and recanalization therapy, vary in pattern and evolution toward HT. Several prognostic and therapeutic predictors for HT are independently associated with pre- and posttreatment permeability derangements.

Key Words: collateral circulation • hemorrhagic transformation • magnetic resonance imaging • permeability • stroke, ischemic • thrombolysis

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