on November 26, 2008
Published online before print November 26, 2008, doi: 10.1161/STROKEAHA.108.522847
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Submitted on April 10, 2008
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. * To whom correspondence should be addressed. 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.
Revised on May 10, 2008
Accepted on June 20, 2008
Patterns and Predictors of Blood–Brain Barrier Permeability Derangements in Acute Ischemic Stroke
Oh Young Bang MD, PhD;
Key words: collateral circulation • hemorrhagic transformation • magnetic resonance imaging • permeability • stroke, ischemic • thrombolysis
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