Blood–brain barrier leakage increases with small vessel disease in acute ischemic stroke

作者：Francesco Arba, Richard J. Leigh, Domenico Inzitari, Steven J. Warach, Marie L. Luby, Kennedy R. Lees, Gregory W. Albers, Stephen M. Davis, Geoffrey Alan Donnan, Marc Fisher, Anthony J. Furlan, James Charles Grotta, Werner Hacke, Dong‐Wha Kang, Chelsea S. Kidwell, Walter J. Koroshetz, Kennedy R. Lees, Michael H. Lev, David S. Liebeskind, Alma Gregory Sorensen, Vincent Thijs, Götz Thomalla, Steven J. Warach, Joanna Marguerite Wardlaw, Max Wintermark · 发表于：Neurology · 年份：2017 · DOI：10.1212/wnl.0000000000004677 · 被引用次数：82 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Cerebrovascular and Carotid Artery Diseases

Objective: In patients with acute ischemic stroke, we aimed to investigate the relation between preexisting small vessel disease (SVD) and the amount of blood–brain barrier (BBB) leakage in ischemic and nonischemic area before IV thrombolysis. Methods: We retrospectively accessed anonymous patient-level data from the Stroke Imaging Repository and the Virtual International Stroke Trials Archive resources and included patients treated with IV thrombolysis with pretreatment MRI. We rated SVD features using validated qualitative magnetic resonance (MR) scales. Leakage of BBB was assessed with postprocessing of perfusion-weighted images. We evaluated associations between SVD features (individually and summed in a global SVD score) and BBB leakage using linear regression analysis, adjusting for major clinical confounders. Results: A total of 212 patients, mean age (±SD) 69.5 years (±16.1), 102 (48%) male, had available MR before IV thrombolysis. Evidence of BBB leakage was present in 175 (80%) and 205 (94%) patients in the ischemic and nonischemic area, respectively. Lacunar infarcts (β = 0.17, p = 0.042) were associated with BBB leakage in the ischemic area, and brain atrophy was associated with BBB leakage in both ischemic (β = 0.20, p = 0.026) and nonischemic (β = 0.27, p = 0.001) areas. Increasing SVD grade was independently associated with BBB leakage in both ischemic (β = 0.26, p = 0.007) and nonischemic (β = 0.27, p = 0.003) area. Conclusions: Global SVD burden is associated...