期刊
EUROPEAN JOURNAL OF NEUROLOGY
卷 28, 期 9, 页码 3147-3154出版社
WILEY
DOI: 10.1111/ene.14985
关键词
acute ischemic stroke; blood-brain barrier; CT perfusion; hemorrhagic transformation; reperfusion therapy
资金
- Italian Ministry of Health [RF-20-11-02348240]
In patients with acute ischemic stroke undergoing reperfusion therapy, pretreatment blood-brain barrier leakage was found to be associated with hemorrhagic transformation, suggesting a potential role in identifying patients at risk of hemorrhagic transformation.
Background and purpose In patients with acute ischemic stroke treated with reperfusion therapy we aimed to evaluate whether pretreatment blood-brain barrier (BBB) leakage is associated with subsequent hemorrhagic transformation (HT). Methods We prospectively screened patients with acute ischemic stroke treated with intravenous thrombolysis and/or endovascular treatment. Before treatment, each patient received computed tomography (CT), CT angiography, and CT perfusion. We assessed pretreatment BBB leakage within the ischemic area using the volume transfer constant (K-trans) value. Our primary outcome was relevant HT, defined as hemorrhagic infarction type 2 or parenchymal hemorrhage type 1 or 2. We evaluated independent associations between BBB leakage and HT using logistic regression, adjusting for age, sex, baseline stroke severity, Alberta Stroke Program Early CT Score (ASPECTS) >= 6, treatment type, and onset-to-treatment time. Results We enrolled 171 patients with available assessment of BBB leakage. The patients' mean (+/- SD) age was 75.5 (+/- 11.8) years, 86 (50%) were men, and the median (interquartile range) National Institutes of Health Stroke Scale score was 18 (12-23). A total of 32 patients (18%) received intravenous thrombolysis, 102 (60%) underwent direct endovascular treatment, and 37 (22%) underwent both. Patients with relevant HT (N = 31;18%) had greater mean BBB leakage (K-trans 0.77 vs. 0.60; p = 0.027). After adjustment in the logistic regression model, we found that BBB leakage was associated both with a more than twofold risk of relevant HT (odds ratio [OR] 2.50; 95% confidence interval [CI] 1.03-6.03 per K-trans point increase; OR 2.34; 95% CI 1.06-5.17 for K-trans values > 0.63 [mean BBB leakage value]) and with symptomatic intracerebral hemorrhage (OR 4.30; 95% CI 1.13-13.77 per K-trans point increase). Conclusion Pretreatment BBB leakage before reperfusion therapy was associated with HT, and may help to identify patients at risk of HT.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据