Reperfusion facilitates reversible disruption of the human blood-brain barrier following acute ischaemic stroke

We aimed to detect early changes of the blood-brain barrier permeability (BBBP) in acute ischaemic stroke (AIS), with or without reperfusion, and find out whether BBBP can predict clinical outcomes. Consecutive AIS patients imaged with computed tomographic perfusion (CTP) before and 24 h after treatment were included. The relative permeability-surface area product (rPS) was calculated within the hypoperfused region (rPS(hypo-i)), non-hypoperfused region of ischaemic hemisphere (rPS(nonhypo-i)) and their contralateral mirror regions (rPS(hypo-c) and rPS(nonhypo-c)). The changes of rPS were analysed using analysis of variance (ANOVA) with repeated measures. Logistic regression was used to identify independent predictors of unfavourable outcome. Fifty-six patients were included in the analysis, median age was 76 (IQR 62-81) years and 28 (50%) were female. From baseline to 24 h after treatment, rPS(hypo-i), rPS(nonhypo-i) and rPS(hypo-c) all decreased significantly. The decreases in rPS(hypo-i) and rPS(hypo-c) were larger in the reperfusion group than non-reperfusion group. The rPS(hypo-i) at follow-up was a predictor for unfavourable outcome (OR 1.131; 95% CI 1.018-1.256; P = 0.022). Early disruption of BBB in AIS is reversible, particularly when greater reperfusion is achieved. Elevated BBBP at 24 h after treatment, not the pretreatment BBBP, predicts unfavourable outcome. aEuro cent Early disruption of blood-brain barrier (BBB) in stroke is reversible after treatment. aEuro cent The reversibility of BBB permeability is associated with reperfusion. aEuro cent Unfavourable outcome is associated with BBB permeability at 24 h after treatment. aEuro cent Contralateral non-ischaemic hemisphere is not 'normal' during an acute stroke.