Evidence of reperfusion injury, exacerbated by thrombolytic therapy, in human focal brain ischemia using a novel imaging marker of early blood-brain barrier disruption

Steven Warach, Lawrence L. Latour

Research output: Contribution to journalArticle

225 Citations (Scopus)

Abstract

Loss of integrity of the blood-brain barrier (BBB) resulting from ischemia and reperfusion is a hypothesized precursor to hemorrhagic transformation (HT) and worse clinical outcome than would be expected from the beneficial effects of reperfusion. We used a novel magnetic resonance imaging marker to characterize early BBB disruption in acute focal brain ischemia and tested associations with reperfusion, HT, and poor outcome (modified Rankin score >2). The BBB disruption was evident as delayed gadolinium enhancement of cerebrospinal fluid space on fluid-attenuated inversion recovery (FLAIR) images and, for convenience, has been termed hyperintense acute reperfusion marker (HARM). HARM was found in 47 of 144 (33%) ischemic stroke patients. Reperfusion was found to be the strongest independent predictor of early BBB disruption (P=0.018) in multivariate analysis. HARM was associated with HT and worse clinical outcome (after adjustment for initial severity). It was also associated with more severe strokes at onset and greater age. Because the timing of the disruption was early enough (median estimate 3.8 hours from onset) to make it relevant to acute thrombolytic therapy, early BBB disruption as defined by HARM may be a promising target for adjunctive therapy to reduce the complications associated with thrombolytic therapy, broaden the therapeutic window, and improve clinical outcome.

Original languageEnglish (US)
Pages (from-to)2659-2661
Number of pages3
JournalStroke
Volume35
Issue number11 SUPPL. 1
DOIs
StatePublished - Nov 2004

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Thrombolytic Therapy
Reperfusion Injury
Brain Ischemia
Blood-Brain Barrier
Reperfusion
Stroke
Gadolinium
Age of Onset
Cerebrospinal Fluid
Multivariate Analysis
Ischemia
Magnetic Resonance Imaging
Therapeutics

Keywords

  • Acute care
  • Blood-brain barrier
  • Stroke, hemorrhagic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Evidence of reperfusion injury, exacerbated by thrombolytic therapy, in human focal brain ischemia using a novel imaging marker of early blood-brain barrier disruption. / Warach, Steven; Latour, Lawrence L.

In: Stroke, Vol. 35, No. 11 SUPPL. 1, 11.2004, p. 2659-2661.

Research output: Contribution to journalArticle

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