Blood-brain barrier integrity of stroke patients presenting in an extended time window
Blood-brain barrier integrity of stroke patients presenting in an extended time window
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DOI：
10.1186/s12883-020-01634-2
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发表时间：
2020-02-13
期刊：
影响因子：
2.6
通讯作者：
Leigh, Richard
中科院分区：
文献类型：
--
作者：
Butler, Jarrhett;Heidari, Parisa;Leigh, Richard
背景：目前的指南限制在4.5小时内出现血栓的中风患者进行溶栓治疗，以尽量减少出血性并发症的风险。出血的风险随着血脑屏障（BBB）破坏的增加而增加。本研究旨在确定在IV-tPA治疗窗口外出现的患者队列中，血脑屏障的破坏是否与时间有关，以及有多少比例的患者可以安全治疗。方法：我们分析了2011年至2015年期间未治疗的脑卒中患者，这些患者在症状出现后4至24小时的时间窗内进行了MRI检查。血脑屏障的通透性测量在缺血组织中使用动态敏感性对比成像的应用。根据血脑屏障破坏阈值20%将患者分为两组，并使用逻辑回归进行比较。结果在最终分析的222例患者中，超过一半（129例，58%）的血脑屏障完整性低于20%的阈值。在人群中，症状发作后的成像时间与血脑屏障破坏量之间没有关系（p = 0.138）；血脑屏障的破坏差异很大。结论：评估血脑屏障完整性可能有助于扩大脑卒中患者的治疗窗口，从而确定可以考虑溶栓治疗的个体。
Background Current guidelines limit thrombolytic treatment of stroke to those patients who present within 4.5 h to minimize the risk of hemorrhagic complications. Risk of hemorrhage increases with increasing blood-brain barrier (BBB) disruption. This study aimed to determine, in a cohort of patients presenting outside of an IV-tPA treatment window, whether disruption of the BBB is time dependent, and what proportion of patients could be safely treated. Methods We analyzed untreated stroke patients, seen between 2011 and 2015, who had MRI studies in the time window of 4 to 24 h from symptoms onset. Permeability of the BBB was measured within the ischemic tissue using an application of dynamic susceptibility contrast imaging. Patients were dichotomized into two groups based on a 20% threshold of BBB disruption and compared using logistic regression. Results Of the 222 patients included in the final analysis, over half, 129 (58%), had preserved BBB integrity below the 20% threshold. There was no relationship between time imaged after symptom onset and the amount of BBB disruption (p = 0.138) across the population; BBB disruption varied widely. Conclusions Estimating BBB integrity may help to expand the treatment window for stroke patients by identifying those individuals for whom thrombolytic therapy can be considered.