Early Blood‐Brain Barrier Disruption after Mechanical Thrombectomy in Acute Ischemic Stroke

Shi, Zhong‐Song; Duckwiler, Gary; Jahan, Reza; Tateshima, Satoshi; Szeder, Viktor; Saver, Jeffrey L.; Kim, Doojin; Sharma, Latisha; Vespa, Paul; Salamon, Noriko; Villablanca, J. Pablo; Viñuela, Fernando; Feng, Lei; Loh, Yince; Liebeskind, David S

doi:10.1111/jon.12504

Cited by 48 publications

(35 citation statements)

References 30 publications

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“…In any of the cases, HT occurs when cerebral blood flow is restored to damaged blood vessels weakened by ischemic stroke (47,66). In fact, the disruption and leakiness of the BBB on pretreatment imaging is correlated with the severity of HT (123). Furthermore, a higher BBBP is associated with not only the severity of but also the likelihood to develop HT (64,124,125).…”

Section: Hemorrhagic Transformation: the Role Of Bbb Permeabilitymentioning

confidence: 99%

“…Dual-energy head CT is currently the gold standard to distinguish both conditions in control CT post-EVT (147,148). One study (123) found BBB disruption evaluated by non-contrast CT scan within 3 h of the procedure and defined as parenchymal hyperdensity on CT scan (including both blood and contrast medium), occurring in 61% of patients. Multiple thrombectomy passes have also been independently associated with a significant increase in BBB disruption as evaluated by hyperintense acute reperfusion marker (HARM) which is a hyperintensity on T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI following an injection of gadolinium-based contrast agent (149).…”

Section: Ht Motivated By Reperfusion Treatments: Thrombolysis and Endmentioning

confidence: 99%

“…This association, however, has been contested (166,167). Hyperdensities seen in control non-contrast CT scan after MT consist of early intraparenchymal hyperdense areas as a result of increased permeability and may predict HT after MT (123). Currently, dynamic contrast-enhanced (DCE) MRI is considered the most widely used imaging technique for BBB research (168) since it provides quantitative estimates of contrast agent leakage at moderate spatial resolution.…”

Section: Imaging Toolsmentioning

confidence: 99%

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Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

et al. 2020

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The blood–brain barrier (BBB) is a dynamic interface responsible for maintaining the central nervous system homeostasis. Its unique characteristics allow protecting the brain from unwanted compounds, but its impairment is involved in a vast number of pathological conditions. Disruption of the BBB and increase in its permeability are key in the development of several neurological diseases and have been extensively studied in stroke. Ischemic stroke is the most prevalent type of stroke and is characterized by a myriad of pathological events triggered by an arterial occlusion that can eventually lead to fatal outcomes such as hemorrhagic transformation (HT). BBB permeability seems to follow a multiphasic pattern throughout the different stroke stages that have been associated with distinct biological substrates. In the hyperacute stage, sudden hypoxia damages the BBB, leading to cytotoxic edema and increased permeability; in the acute stage, the neuroinflammatory response aggravates the BBB injury, leading to higher permeability and a consequent risk of HT that can be motivated by reperfusion therapy; in the subacute stage (1–3 weeks), repair mechanisms take place, especially neoangiogenesis. Immature vessels show leaky BBB, but this permeability has been associated with improved clinical recovery. In the chronic stage (>6 weeks), an increase of BBB restoration factors leads the barrier to start decreasing its permeability. Nonetheless, permeability will persist to some degree several weeks after injury. Understanding the mechanisms behind BBB dysregulation and HT pathophysiology could potentially help guide acute stroke care decisions and the development of new therapeutic targets; however, effective translation into clinical practice is still lacking. In this review, we will address the different pathological and physiological repair mechanisms involved in BBB permeability through the different stages of ischemic stroke and their role in the development of HT and stroke recovery.

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Section: Hemorrhagic Transformation: the Role Of Bbb Permeabilitymentioning

confidence: 99%

Section: Ht Motivated By Reperfusion Treatments: Thrombolysis and Endmentioning

confidence: 99%

Section: Imaging Toolsmentioning

confidence: 99%

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Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

et al. 2020

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“…1 However, hyperdense lesions apparent on postprocedural computed tomography (CT) after EVT are common and may be secondary to contrast extravasation or intracerebral hemorrhage (ICH). 2,3 Contrast extravasation is believed to be caused by leakage from vessels into extracellular spaces due to increased permeability of the blood brain barrier (BBB), [4][5][6] which relates to increased risk of hemorrhagic transformation (HT) 2,7-9 and poor prognosis. 5,8,10 Therefore, identification of these high-density lesions on CT as contrast extravasation or ICH is critical and has significant clinical ramifications.…”

Section: Introductionmentioning

confidence: 99%

Contrast Extravasation is Predictive of Poor Clinical Outcomes in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke in the Anterior Circulation

Chen

Zhang²,

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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“…In addition, mTBI can be associated with a rapid disruption of blood-brain barrier (BBB) integrity followed by eventual development of brain damage [e.g., (7)(8)(9)]. BBB disruption after TBI is also a risk factor for secondary brain hemorrhage (10)(11)(12). It is therefore important to detect early BBB disruption to predict the development of persistent post-concussion disability.…”

Section: Introductionmentioning

confidence: 99%

Is Salivary S100B a Biomarker of Traumatic Brain Injury? A Pilot Study

et al. 2020

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Traumatic brain injury (TBI) results in short and long-term disability neurodegeneration. Mild traumatic brain injury (mTBI) represents up to 85% of head injuries; diagnosis and early management is based on computed tomography (CT) or in-hospital observation, which are time-and cost-intensive. CT involves exposure to potentially harmful ionizing radiation and >90% of the scans are negative. Blood-brain barrier (BBB) damage is suspected pathological event post-TBI contributing to long-term sequelae and a reliable and rapid point-of-care test to screen those who can safely forego acute head CT would be of great help in evaluating patients with an acute mTBI. In this pilot study, 15 adult patients with suspected TBI (mean age = 47 years, range 18-79) and 15 control subjects (mean age = 33 years, range 23-53) were enrolled. We found that the average salivary S100B level was 3.9 fold higher than blood S100B, regardless of the presence of pathology. [S100B] saliva positively correlated with [S100B] serum (Pearson' coefficient = 0.79; p < 0.01). Salivary S100B levels were as effective in differentiating TBI patients from control subjects as serum levels (Control vs. TBI: p < 0.01; Serum ROC AUC = 0.94 and Saliva ROC AUC = 0.75). I These initial results suggest that measuring salivary S100B could represent an alternative to serum S100B in the diagnosis of TBI. Larger and confirmatory trials are needed to define salivary biomarker kinetics in relation to TBI severity and the possible roles of gender, ethnicity and age in influencing salivary S100B levels.

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Early Blood‐Brain Barrier Disruption after Mechanical Thrombectomy in Acute Ischemic Stroke

Abstract: Moderate BBB disruption is common after mechanical thrombectomy in a quarter of patients with acute ischemic stroke and increases the risk of intracranial hemorrhage and poor outcome.

Cited by 48 publications

References 30 publications

Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

Contrast Extravasation is Predictive of Poor Clinical Outcomes in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke in the Anterior Circulation

Is Salivary S100B a Biomarker of Traumatic Brain Injury? A Pilot Study

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