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

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusion

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.

Key points

• Early disruption of blood–brain barrier (BBB) in stroke is reversible after treatment.

• The reversibility of BBB permeability is associated with reperfusion.

• Unfavourable outcome is associated with BBB permeability at 24 h after treatment.

• Contralateral non-ischaemic hemisphere is not 'normal' during an acute stroke.