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French S, Arias J, Bolakale-Rufai I, Zahra S, Rubab Khakwani KZ, Bedrick EJ, Serrano GE, Beach TG, Reiman E, Weinkauf C. Serum detection of blood brain barrier injury in subjects with a history of stroke and transient ischemic attack. JVS Vasc Sci 2024; 5:100206. [PMID: 38873494 PMCID: PMC11170223 DOI: 10.1016/j.jvssci.2024.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/13/2024] [Indexed: 06/15/2024] Open
Abstract
Objective Stroke and transient ischemic attack may have long-term negative effects on the blood-brain barrier (BBB) and promote endothelial inflammation, both of which could increase neurodegeneration and dementia risk beyond the cell death associated with the index event. Methods Serum from 88 postmortem subjects in the Arizona Study of Aging and Neurodegenerative Disorders were analyzed by sandwich ELISA for specific biomarkers to investigate the effects of cerebrovascular accidents (CVAs) on BBB integrity and endothelial activation. Statistical analyses were performed using the Mann-Whitney U Test, Spearman rank correlation, and linear/logistic regressions adjusted for potential confounders; a P-value < .05 was considered significant for all analyses. Results Serum PDGFRẞ, a putative biomarker of BBB injury, was significantly increased in subjects with vs without a history of CVA who had similar cardiovascular risk factors (P < .01). This difference was stable after adjusting for age, hypertension, and other potential confounders in regression analysis (odds ratio, 27.02; 95% confidence interval, 2.61-411.7; P < .01). In addition, PDGFRẞ was positively associated with VCAM-1, a biomarker of endothelial inflammation (ρ = 0.42; P < .01). Conclusions Our data suggest that patients with stroke or transient ischemic attack have lasting changes in the BBB. Still more, this demonstrates the utility of PDGFRẞ as a serum-based biomarker of BBB physiology, a potentially powerful tool in studying the role of the BBB in various neurodegenerative diseases and COVID infection sequelae. Clinical Relevance Our data demonstrate the utility of serum PDGFRẞ, a putative biomarker of BBB integrity in the setting of stroke and TIA (CVA). A serum biomarker of BBB integrity could be a useful tool to detect early BBB damage and allow prospective work to study how such damage affects long-term neurodegenerative risk. Since BBB disruption occurs early in ADRD development, it could be monitored to help better understand disease progression and involvement of vascular pathways in ADRD.
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Affiliation(s)
- Scott French
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
| | - Juan Arias
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
| | | | - Summan Zahra
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
| | | | - Edward J. Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, AZ
| | | | | | - Eric Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ
| | - Craig Weinkauf
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
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Dai L, Sun Z, Jiang J, Wei J, Song X, Chen S, Li Y. Synchronous Superficial Middle Cerebral Vein Outflow Correlates Favorable Tissue Fate After Mechanical Thrombectomy for Acute Ischemic Stroke. Acad Radiol 2024; 31:1548-1557. [PMID: 37541827 DOI: 10.1016/j.acra.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to determine the association between hemispheric synchrony in venous outflow at baseline and tissue fate after mechanical thrombectomy (MT) for acute ischemic stroke (AIS). MATERIALS AND METHODS A two-center retrospective analysis involving AIS patients who underwent MT was performed. The four cortical veins of interest include the superficial middle cerebral vein (SMCV), sphenoparietal sinus (SS), vein of Labbé (VOL), and vein of Trolard (VOT). Baseline computed tomography perfusion data were used to compare the following outflow parameters between the hemispheres: first filling time (△FFT), time to peak (△TTP) and total filling time (△TFT). Synchronous venous outflow was defined as △FFT = 0. Multivariable regression analyses were performed to evaluate the association of venous outflow synchrony with penumbral salvage, infarct growth, and intracranial hemorrhage (ICH) after MT. RESULTS A total of 151 patients (71.4 ± 13.2 years, 65.6% women) were evaluated. Patients with synchronous SMCV outflow demonstrated significantly greater penumbral salvage (41.3 mL vs. 33.1 mL, P = 0.005) and lower infarct growth (9.0 mL vs. 14.4 mL, P = 0.015) compared to those with delayed SMCV outflow. Higher △FFTSMCV (β = -1.44, P = 0.013) and △TTPSMCV (β = -0.996, P = 0.003) significantly associated with lower penumbral salvage, while higher △FFTSMCV significantly associated with larger infarct growth (β = 1.09, P = 0.005) and increased risk of ICH (odds ratio [OR] = 1.519, P = 0.047). CONCLUSION Synchronous SMCV outflow is an independent predictor of favorable tissue outcome and low ICH risk, and thereby carries the potential as an auxiliary radiological marker aiding the treatment planning of AIS patients.
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Affiliation(s)
- Lisong Dai
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China (L.D., Z.S., J.J., X.S., S.C., Y.L.)
| | - Zheng Sun
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China (L.D., Z.S., J.J., X.S., S.C., Y.L.)
| | - Jingxuan Jiang
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China (L.D., Z.S., J.J., X.S., S.C., Y.L.); Department of Radiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China (J.J.)
| | - Jianyong Wei
- Clinical Research Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (J.W.)
| | - Xinyu Song
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China (L.D., Z.S., J.J., X.S., S.C., Y.L.)
| | - Shen Chen
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China (L.D., Z.S., J.J., X.S., S.C., Y.L.)
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China (L.D., Z.S., J.J., X.S., S.C., Y.L.).
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Ru X, Zhao S, Chen W, Wu J, Yu R, Wang D, Dong M, Wu Q, Peng D, Song Y. A weakly supervised deep learning model integrating noncontrasted computed tomography images and clinical factors facilitates haemorrhagic transformation prediction after intravenous thrombolysis in acute ischaemic stroke patients. Biomed Eng Online 2023; 22:129. [PMID: 38115029 PMCID: PMC10731772 DOI: 10.1186/s12938-023-01193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Haemorrhage transformation (HT) is a serious complication of intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS). Accurate and timely prediction of the risk of HT before IVT may change the treatment decision and improve clinical prognosis. We aimed to develop a deep learning method for predicting HT after IVT for AIS using noncontrast computed tomography (NCCT) images. METHODS We retrospectively collected data from 828 AIS patients undergoing recombinant tissue plasminogen activator (rt-PA) treatment within a 4.5-h time window (n = 665) or of undergoing urokinase treatment within a 6-h time window (n = 163) and divided them into the HT group (n = 69) and non-HT group (n = 759). HT was defined based on the criteria of the European Cooperative Acute Stroke Study-II trial. To address the problems of indiscernible features and imbalanced data, a weakly supervised deep learning (WSDL) model for HT prediction was constructed based on multiple instance learning and active learning using admission NCCT images and clinical information in addition to conventional deep learning models. Threefold cross-validation and transfer learning were performed to confirm the robustness of the network. Of note, the predictive value of the commonly used scales in clinics associated with NCCT images (i.e., the HAT and SEDAN score) was also analysed and compared to measure the feasibility of our proposed DL algorithms. RESULTS Compared to the conventional DL and ML models, the WSDL model had the highest AUC of 0.799 (95% CI 0.712-0.883). Significant differences were observed between the WSDL model and five ML models (P < 0.05). The prediction performance of the WSDL model outperforms the HAT and SEDAN scores at the optimal operating point (threshold = 1.5). Further subgroup analysis showed that the WSDL model performed better for symptomatic intracranial haemorrhage (AUC = 0.833, F1 score = 0.909). CONCLUSIONS Our WSDL model based on NCCT images had relatively good performance for predicting HT in AIS and may be suitable for assisting in clinical treatment decision-making.
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Affiliation(s)
- Xiaoshuang Ru
- Department of Radiology, Central Hospital of Dalian University of Technology, No. 826 Xinan Rd, Shahekou District, Dalian, 116033, Liaoning Province, China
| | - Shilong Zhao
- Department of Radiology, Affliated ZhongShan Hospital of Dalian University, No. 6 Jiefang Rd, Zhongshan District, Dalian, 116001, Liaoning Province, China
| | - Weidao Chen
- InferVision Medical Technology Company Ltd, 25F, Building E, Yuanyang International Center, Chaoyang District, Beijing, 100025, China
| | - Jiangfen Wu
- InferVision Medical Technology Company Ltd, 25F, Building E, Yuanyang International Center, Chaoyang District, Beijing, 100025, China
| | - Ruize Yu
- InferVision Medical Technology Company Ltd, 25F, Building E, Yuanyang International Center, Chaoyang District, Beijing, 100025, China
| | - Dawei Wang
- InferVision Medical Technology Company Ltd, 25F, Building E, Yuanyang International Center, Chaoyang District, Beijing, 100025, China
| | - Mengxing Dong
- InferVision Medical Technology Company Ltd, 25F, Building E, Yuanyang International Center, Chaoyang District, Beijing, 100025, China
| | - Qiong Wu
- Department of Neurology, Central Hospital of Dalian University of Technology, No. 826 Xinan Rd, Shahekou District, Dalian, 116033, Liaoning Province, China
| | - Daoyong Peng
- Department of Neurology, Central Hospital of Dalian University of Technology, No. 826 Xinan Rd, Shahekou District, Dalian, 116033, Liaoning Province, China
| | - Yang Song
- Department of Radiology, Central Hospital of Dalian University of Technology, No. 826 Xinan Rd, Shahekou District, Dalian, 116033, Liaoning Province, China.
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Mubarak F, Fatima H, Mustafa MS, Shafique MA, Abbas SR, Rangwala HS. Assessment Precision of CT Perfusion Imaging in the Detection of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e44396. [PMID: 37791142 PMCID: PMC10542215 DOI: 10.7759/cureus.44396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Stroke, a prevalent medical emergency, comprises ischemic and hemorrhagic subtypes, with acute ischemic stroke (AIS) being a predominant type. The application of computed tomography perfusion (CTP) imaging has gained prominence due to its rapidity and accessibility in stroke evaluation. This study systematically reviews and conducts a meta-analysis of existing literature to assess the diagnostic accuracy of CTP in detecting AIS and predicting hemorrhagic transformation (HT). Employing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an extensive search was conducted across electronic databases and relevant radiology journals. Studies conducted between 2007 and 2023 that fulfilled predetermined inclusion criteria underwent quality assessment using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2) tool. Cochrane diagnostic accuracy tools were used for data extraction. Thirteen studies involving a total of 1014 patients were included in the analysis. The diagnostic performance of CTP in predicting HT demonstrated high sensitivity (86.7%) and moderate specificity (77.8%), resulting in an overall accuracy of 79.1%. The negative predictive value (NPV) was notably high (92.9%), signifying its efficacy in excluding patients at risk of HT. The positive predictive value (PPV) was comparatively lower (60.3%), highlighting the need for clinical context when making thrombolysis decisions. The false positive rate was 16.2%, while the false negative rate was minimal (9.8%). Subgroup analysis underscored consistent sensitivity and specificity across diverse imaging metrics. The findings of this study emphasize the promising diagnostic accuracy of CTP imaging in predicting HT subsequent to AIS. This non-invasive technique can aid treatment decisions and patient management strategies. By effectively assessing perfusion status and offering predictive insights, CTP imaging improves stroke intervention choices, especially in identifying patients with a lower risk of HT.
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Affiliation(s)
- Fatima Mubarak
- Department of Radiology, Aga Khan University Hospital, Karachi, PAK
| | - Hareer Fatima
- Department of Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | | | - Syed Raza Abbas
- Department of Medicine, Dow University of Health Sciences, Karachi, PAK
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Elsaid N, Bigliardi G, Dell’Acqua ML, Vandelli L, Ciolli L, Picchetto L, Borzì G, Ricceri R, Pentore R, Vallone S, Meletti S, Saied A. The role of automated computed topography perfusion in prediction of hemorrhagic transformation after acute ischemic stroke. Neuroradiol J 2023; 36:182-188. [PMID: 35850570 PMCID: PMC10034700 DOI: 10.1177/19714009221111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The role of computed tomography perfusion (CTP) in prediction of hemorrhagic transformation (HT) has been evolving. We aimed to study the role of automated perfusion post-processing software in prediction of HT using the commercially available RAPID software. METHODS Two hundred eighty-two patients with anterior circulation ischemic stroke, who underwent CTP with RAPID automated post-processing, were retrospectively enrolled and divided into HT (n = 91) and non-HT groups (n = 191). The automated RAPID-generated perfusion maps were reviewed. Mismatch volume and ratio, time to maximum (Tmax) > 4-10s volumes, hypoperfusion index, cerebral blood flow (CBF) < 20-38% volumes, cerebral blood volume (CBV) < 34%-42% volumes, and CBV index were recorded and analyzed. RESULTS The volumes of brain tissues suffering from reduction of cerebral blood flow (CBF < 20%-38%), reduction in cerebral blood volumes (CBV < 34-42%), and delayed contrast arrival times (Tmax > 4-10s) were significantly higher in the HT group. The mismatch volumes were also higher in the HT group (p = .001). Among these parameters, the Tmax > 6s volume was the most reliable and sensitive predictor of HT (p = .001, AUC = 0.667). However, the combination of the perfusion parameters can slightly improve the diagnostic efficiency (AUC = 0.703). There was no statistically significant difference between the non-HT group and either the parenchymal or the symptomatic subtypes. CONCLUSION The RAPID automated CTP parameters can provide a reliable predictor of HT overall but not the parenchymal or the symptomatic subtypes. The infarct area involving the penumbra and core represented by the Tmax > 6s threshold is the most sensitive predictor; however, the combination of the perfusion parameters can slightly improve the diagnostic efficiency.
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Affiliation(s)
- Nada Elsaid
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
- Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Guido Bigliardi
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Maria Luisa Dell’Acqua
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Laura Vandelli
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Ludovico Ciolli
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Livio Picchetto
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Giuseppe Borzì
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Riccardo Ricceri
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Roberta Pentore
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Stefano Vallone
- Neuroradiology, Department of
Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Stefano Meletti
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Ahmed Saied
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
- Department of Neurology, Mansoura University, Mansoura, Egypt
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6
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Hoving JW, van Voorst H, Peerlings D, Daems JD, Koopman MS, Wouters A, Kappelhof M, LeCouffe NE, Treurniet KM, Bruggeman AAE, Rinkel LA, van den Wijngaard IR, Coutinho JM, van der Lugt A, Marquering HA, Roos YBWEM, Majoie CBLM, Emmer BJ. Association between computed tomography perfusion and the effect of intravenous alteplase prior to endovascular treatment in acute ischemic stroke. Neuroradiology 2023; 65:1053-1061. [PMID: 36884080 PMCID: PMC10169898 DOI: 10.1007/s00234-023-03139-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Intravenous alteplase (IVT) prior to endovascular treatment (EVT) is neither superior nor noninferior to EVT alone in acute ischemic stroke patients. We aim to assess whether the effect of IVT prior to EVT differs according to CT perfusion (CTP)-based imaging parameters. METHODS In this retrospective post hoc analysis, we included patients from the MR CLEAN-NO IV with available CTP data. CTP data were processed using syngo.via (version VB40). We performed multivariable logistic regression to obtain the effect size estimates (adjusted common odds ratio a[c]OR) on 90-day functional outcome (modified Rankin Scale [mRS]) and functional independence (mRS 0-2) for CTP parameters with two-way multiplicative interaction terms between IVT administration and the studied parameters. RESULTS In 227 patients, median CTP-estimated core volume was 13 (IQR 5-35) mL. The treatment effect of IVT prior to EVT on outcome was not altered by CTP-estimated ischemic core volume, penumbral volume, mismatch ratio, and presence of a target mismatch profile. None of the CTP parameters was significantly associated with functional outcome after adjusting for confounders. CONCLUSION In directly admitted patients with limited CTP-estimated ischemic core volumes who presented within 4.5 h after symptom onset, CTP parameters did not statistically significantly alter the treatment effect of IVT prior to EVT. Further studies are needed to confirm these results in patients with larger core volumes and more unfavorable baseline perfusion profiles on CTP imaging.
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Affiliation(s)
- Jan W Hoving
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands. .,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location University of Amsterdam, Office G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Henk van Voorst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Daan Peerlings
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jasper D Daems
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Miou S Koopman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Anke Wouters
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, the Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Natalie E LeCouffe
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, the Netherlands
| | - Kilian M Treurniet
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.,Department of Radiology, The Hague Medical Center, The Hague, the Netherlands
| | - Agnetha A E Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Leon A Rinkel
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, the Netherlands
| | | | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, the Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, the Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
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Yang M, Tang L, Hu Z, Tang X. Application of Neuroimaging for the Prediction of Hemorrhagic Transformation after Intravenous Thrombolysis in Acute Ischemic Stroke. Cerebrovasc Dis 2023; 52:1-10. [PMID: 35661647 DOI: 10.1159/000524749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ischemic stroke is a common cerebrovascular disease with high morbidity, disability, and mortality worldwide. Currently, recombinant tissue plasminogen activator is the main intravenous thrombolysis agent for the treatment of acute ischemic stroke within 4.5 h after onset. Hemorrhagic transformation (HT) is the most serious complication of intravenous thrombolysis, which can significantly aggravate clinical poor prognosis. Therefore, it is important to early predict the risk of post-thrombolysis HT in patients with acute ischemic stroke. SUMMARY Recently, several studies have reported that neuroimaging techniques have potential value in predicting HT after intravenous thrombolysis in patients with acute ischemic stroke. The corresponding neuroimaging parameters may be effective predictors of HT after intravenous thrombolysis. In this review, we summarized and discussed the application of neuroimaging techniques and related parameters in predicting HT after intravenous thrombolysis. KEY MESSAGES Recognizing and understanding the predictive performance of neuroimaging parameters for HT may help assess the risk of HT after intravenous thrombolysis in patients with acute ischemic stroke and make an appropriate treatment decision.
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Affiliation(s)
- Miaomiao Yang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China,
| | - Lisha Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiping Hu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
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8
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Katyal A, Bhaskar SMM. Value of pre-intervention computed tomography perfusion imaging in the assessment of tissue outcome and long-term clinical prognosis in patients with anterior circulation acute ischemic stroke receiving reperfusion therapy: a systematic review. Acta Radiol 2022; 63:1243-1254. [PMID: 34342497 DOI: 10.1177/02841851211035892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Computed tomography perfusion (CTP) imaging has emerged as an important adjunct to the current armamentarium of acute ischemic stroke (AIS) workflow. However, its adoption in routine clinical practice is far from optimal. PURPOSE To investigate the putative association of CTP imaging biomarkers in the assessment of prognosis in acute ischemic stroke. MATERIAL AND METHODS We performed a systematic review of the literature using MEDLINE, EMBASE, and Cochrane Central Register of Clinical Trials focusing on CTP biomarkers, tissue-based and clinical-based patient outcomes. We included randomized controlled trials, prospective cohort studies, and case-controlled studies published from January 2005 to 28 August 2020. Two independent reviewers conducted the study appraisal, data extraction, and quality assessment of the studies. RESULTS A total of 60 full-text studies were included in the final systematic review analysis. Increasing infarct core volume is associated with reduced odds of achieving functional independence (modified Rankin score 0-2) at 90 days and is correlated with the final infarct volume when reperfusion is achieved. CONCLUSION CTP has value in assessing tissue perfusion status in the hyperacute stroke setting and the long-term clinical prognosis of patients with AIS receiving reperfusion therapy. However, the prognostic use of CTP requires optimization and further validation.
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Affiliation(s)
- Anubhav Katyal
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW, Australia.,University of New South Wales (UNSW), South West Sydney Clinical School, Sydney, NSW, Australia
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW, Australia.,Liverpool Hospital & South West Sydney Local Health District (SWSLHD), Department of Neurology & Neurophysiology, Sydney, NSW, Australia.,NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia.,Thrombolysis and Endovascular WorkFLOw Network (TEFLON), Sydney, NSW, Australia
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9
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Chen H, Luo Y, Tsoi B, Gu B, Qi S, Shen J. Angong Niuhuang Wan reduces hemorrhagic transformation and mortality in ischemic stroke rats with delayed thrombolysis: involvement of peroxynitrite-mediated MMP-9 activation. Chin Med 2022; 17:51. [PMID: 35477576 PMCID: PMC9044615 DOI: 10.1186/s13020-022-00595-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/18/2022] [Indexed: 12/22/2022] Open
Abstract
Background Hemorrhagic transformation (HT) is a common complication of delayed tissue plasminogen activator (t-PA) treatment for ischemic stroke. Peroxynitrite plays an important role in the breakdown of blood–brain barrier (BBB) and the development of HT. We tested the hypothesis that Angong Niuhuang Wan (AGNHW), a traditional Chinese medicinal formula, could be used in conjunction with t-PA to protect the BBB, minimize HT, and improve neurological function by suppressing peroxynitrite-mediated matrix metalloproteinase-9 (MMP-9) activation. Methods We first performed quality control study and chemical identification of AGNHW by using UPLC. In animal experiments, male Sprague–Dawley rats were subjected to 5 h of middle cerebral artery occlusion (MCAO) followed by 19 h of reperfusion plus t-PA infusion (10 mg/kg) at 5 h of cerebral ischemia. AGNHW (257 mg/kg) was given orally at 2 h after MCAO. Hemorrhagic transformation was measured using hemorrhagic scores and hemoglobin levels in ischemic brains. Evans blue leakage was utilized to assess the severity of the blood–brain barrier (BBB) damage. The modified neurologic severity score (mNSS) test was used to assess neurological functions. Peroxynitrite and superoxide was detected by using fluorescent probes. MMP-9 activity and expression were examined by gelatin zymography and immunostaining. The antioxidant effects were also studied by using brain microvascular endothelial b.End3 cells exposed to 5 h of oxygen and glucose deprivation (OGD) plus 5 h of reoxygenation with t-PA treatment (20 µg/ml). Results AGNHW significantly reduced the BBB damage, brain edema, reduced hemorrhagic transformation, enhanced neurological function, and reduced mortality rate in the ischemic stroke rats with t-PA treatment. AGNHW reduced peroxynitrite and superoxide in vivo and in vitro and six active chemical compounds were identified from AGNHW with peroxynitrite scavenging activity. Furthermore, AGNHW inhibited MMP-9 activity, and preserved tight junction protein claudin-5 and collagen IV in the ischemic brains. Conclusion AGNHW could be a potential adjuvant therapy with t-PA to protect the BBB integrity, reduce HT, and improve therapeutic outcome in ischemic stroke treatment via inhibiting peroxynitrite-mediated MMP-9 activation. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13020-022-00595-7.
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Affiliation(s)
- Hansen Chen
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, SAR, People's Republic of China
| | - Yunxia Luo
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, SAR, People's Republic of China
| | - Bun Tsoi
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, SAR, People's Republic of China
| | - Bing Gu
- School of Medical Technology, Xuzhou Medical University, Xuzhou, 221002, China
| | - Suhua Qi
- School of Medical Technology, Xuzhou Medical University, Xuzhou, 221002, China.
| | - Jiangang Shen
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, SAR, People's Republic of China. .,State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China. .,School of Medical Technology, Xuzhou Medical University, Xuzhou, 221002, China.
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10
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Hong L, Hsu TM, Zhang Y, Cheng X. Neuroimaging Prediction of Hemorrhagic Transformation for Acute Ischemic Stroke. Cerebrovasc Dis 2022; 51:542-552. [PMID: 35026765 DOI: 10.1159/000521150] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hemorrhagic transformation (HT) is a common complication of acute ischemic stroke, often resulting from reperfusion therapy. Early prediction of HT can enable stroke neurologists to undertake measures to avoid clinical deterioration and make optimal treatment strategies. Moreover, the trend of extending the time window for reperfusion therapy (both for intravenous thrombolysis and endovascular treatment) further requires more precise detection of HT tendency. SUMMARY In this review, we summarized and discussed the neuroimaging markers of HT prediction of acute ischemic stroke patients, mainly focusing on neuroimaging markers of ischemic degree and neuroimaging markers of blood-brain barrier permeability. This review is aimed to provide a concise introduction of HT prediction and to elicit possibilities of future research combining advanced technology to improve the accessibility and accuracy of HT prediction under emergent clinical settings. Key Messages: Substantial studies have utilized neuroimaging, blood biomarkers, and clinical variables to predict HT occurrence. Although huge progress has been made, more individualized and precise HT prediction using simple and robust imaging predictors combining stroke onset time should be the future goal of development.
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Affiliation(s)
- Lan Hong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China,
| | - Tzu-Ming Hsu
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiran Zhang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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11
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Katyal A, Bhaskar SMM. Value of pre-intervention CT perfusion imaging in acute ischemic stroke prognosis. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:774-785. [PMID: 34792033 DOI: 10.5152/dir.2021.20805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Noninvasive imaging plays an important role in acute stroke towards diagnosis and ongoing management of patients. Systemic thrombolysis and endovascular thrombectomy (EVT) are proven treatments currently used in standards of care in acute stroke settings. The role of computed tomography angiography (CTA) in selecting patients with large vessel occlusion for EVT is well established. However, the value of CT perfusion (CTP) imaging in predicting outcomes after stroke remains ambiguous. This article critically evaluates the value of multimodal CT imaging in early diagnosis and prognosis of acute ischemic stroke with a focus on the role of CTP in delineating tissue characteristics, patient selection, and outcomes after reperfusion therapy. Insights on various technical and clinical considerations relevant to CTP applications in acute ischemic stroke, recommendations for existing workflow, and future areas of research are discussed.
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Affiliation(s)
- Anubhav Katyal
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, Australia; University of New South Wales (UNSW), South Western Sydney Clinical School, NSW, Australia
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, Australia; Department of Neurology - Neurophysiology, Liverpool Hospital - South West Sydney Local Health District (SWSLHD), Sydney, Australia;University of New South Wales (UNSW), South Western Sydney Clinical School, NSW, Australia; Ingham Institute for Applied Medical Research, Stroke - Neurology Research Group, Sydney, Australia; NSW Brain Clot Bank, NSW Health Statewide Biobank and NSW Health Pathology, Sydney, NSW, Australia;Thrombolysis and Endovascular WorkFLOw Network (TEFLON), Sydney, Australia
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12
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Guo ZN, Liu J, Chang J, Zhang P, Jin H, Sun X, Yang Y. GAS6/Axl Signaling Modulates Blood-Brain Barrier Function Following Intravenous Thrombolysis in Acute Ischemic Stroke. Front Immunol 2021; 12:742359. [PMID: 34733281 PMCID: PMC8558492 DOI: 10.3389/fimmu.2021.742359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/30/2021] [Indexed: 01/27/2023] Open
Abstract
Background and Purpose Recent studies have shown that several proteins, including Axl, are related to hemorrhagic transformation (HT) following intravenous thrombolysis by affecting blood-brain barrier (BBB) function. However, the effects of these proteins on BBB function have been studied primarily in animal models. In this study, we aimed to identify serum protein markers that predict HT following intravenous thrombolysis in patients with acute ischemic stroke (AIS) and verify whether these serum proteins regulate BBB function and HT in animal stroke models. Methods First, 118 AIS patients were enrolled in this study, including 52 HT patients and 66 non-HT patients. In Step 1, baseline serum levels of Axl, angiopoietin-like 4, C-reactive protein, ferritin, hypoxia-inducible factor-1 alpha, HTRA2, Lipocalin2, matrix metallopeptidase 9, platelet-derived growth factor-BB, and tumor necrosis factor alpha were measured using a quantitative cytokine chip. Next, sequence mutations and variations in genes encoding the differentially expressed proteins identified in Step 1 and subsequent function-related proteins were detected. Finally, we verified whether manipulation of differentially expressed proteins affected BBB function and HT in a hyperglycemia-induced rat stroke model. Results Serum Axl levels were significantly lower in the HT group than in the non-HT group; none of the other protein markers differed significantly between the two groups. Genetic testing revealed that sequence variations of GAS6 (the gene encoding the Axl ligand)-derived long non-coding RNA, GAS6-AS1, were significantly correlated with an increased risk of HT after intravenous thrombolysis. In animal studies, administration of recombinant GAS6 significantly reduced brain infarction and neurological deficits and attenuated BBB disruption and HT. Conclusions Lower serum Axl levels, which may result from sequence variations in GAS6-AS1, are correlated with an increased risk of HT after intravenous thrombolysis in stroke patients. Activation of the Axl signaling pathway by the GAS6 protein may serve as a therapeutic strategy to reduce HT in AIS patients.
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Affiliation(s)
- Zhen-Ni Guo
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jie Liu
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Junlei Chang
- Center for Protein and Cell-based Drugs, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Peng Zhang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hang Jin
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xin Sun
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
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13
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Zhang XX, Yao FR, Zhu JH, Chen ZG, Shen YP, Qiao YN, Shi HC, Liang JH, Wang XM, Fang Q. Nomogram to predict haemorrhagic transformation after stroke thrombolysis: a combined brain imaging and clinical study. Clin Radiol 2021; 77:e92-e98. [PMID: 34657729 DOI: 10.1016/j.crad.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
AIM To construct a novel nomogram by integrating computed tomography perfusion (CTP) and clinical parameters for individualised prediction of haemorrhagic transformation (HT) in intravenous thrombolysis (IVT)-treated acute ischaemic stroke (AIS) patients. METHODS Anterior circulation AIS patients who underwent IVT at a single centre from January 2018 to June 2020 were reviewed retrospectively. The CTP parameters of two regions of interest (ROI), the entire perfusion lesion areas, and the infract core areas, were assessed. HT was documented by follow-up CT 24 ± 2 h after IVT. Multivariable logistic regression was conducted by including clinical variables and CTP parameters to identify the independent predictors of HT. A nomogram was developed based on the independent predictors. The discriminative value and calibration of the nomogram were tested by concordance indexes (C-indexes) and calibration plots. Internal validation was performed using fivefold cross-validation. RESULTS The nomogram was generated using the complete data from 341 patients. Seven variables were included in the final nomogram, including: the relative cerebral blood volume (rCBV), permeability surface (PS), and relative PS (rPS) in infract core areas, the relative time to maximum (rTmax) and rPS in entire perfusion lesion areas, the National Institutes of Health Stroke Scale (NIHSS), and atrial fibrillation (AF). The C-indexes were 0.815 and 0.817 for the nomogram and internal validation. The calibration plots showed excellent agreement. CONCLUSION This is the first study establishing a nomogram based on CTP and clinical parameters to predict HT after stroke thrombolysis.
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Affiliation(s)
- X-X Zhang
- Department of Neurology, Yancheng Third People's Hospital, Yancheng, 224000, Jiangsu Province, China; Department of Neurology, The First Affiliated Hospital of Soochow University, Soochow, 215000, Jiangsu, China
| | - F-R Yao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China
| | - J-H Zhu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Soochow, 215000, Jiangsu, China
| | - Z-G Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Soochow, 215000, Jiangsu, China
| | - Y-P Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215000, Jiangsu, China
| | - Y-N Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215000, Jiangsu, China
| | - H-C Shi
- Department of Neurology, Yancheng Third People's Hospital, Yancheng, 224000, Jiangsu Province, China
| | - J-H Liang
- Department of Imaging, Medical College of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - X-M Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.
| | - Q Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Soochow, 215000, Jiangsu, China.
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14
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Arba F, Rinaldi C, Caimano D, Vit F, Busto G, Fainardi E. Blood-Brain Barrier Disruption and Hemorrhagic Transformation in Acute Ischemic Stroke: Systematic Review and Meta-Analysis. Front Neurol 2021; 11:594613. [PMID: 33551955 PMCID: PMC7859439 DOI: 10.3389/fneur.2020.594613] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/07/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: Hemorrhagic transformation (HT) is a complication of reperfusion therapy for acute ischemic stroke. Blood–brain barrier (BBB) disruption is a crucial step toward HT; however, in clinical studies, there is still uncertainty about this relation. Hence, we conducted a systematic review and meta-analysis to summarize the current evidence. Methods: We performed systematic review and meta-analysis of observational studies from January 1990 to March 2020 about the relation between BBB disruption and HT in patients with acute ischemic stroke with both computed tomography (CT) and magnetic resonance (MR) assessment of BBB. The outcome of interest was HT at follow-up imaging evaluation (within 48 h from symptom onset). We pooled data from available univariate odds ratios (ORs) in random-effects models with DerSimonian–Laird weights and extracted cumulative ORs. Results: We included 30 eligible studies (14 with CT and 16 with MR), N = 2,609 patients, with 88% and 70% of patients included in CT and MR studies treated with acute stroke therapy, respectively. The majority of studies were retrospective and had high or unclear risk of bias. BBB disruption was measured with consistent methodology in CT studies, whereas in MR studies, there was more variability. All CT studies provided a BBB disruption cutoff predictive of HT. Four CT and 10 MR studies were included in the quantitative analysis. We found that BBB disruption was associated with HT with both CT (OR = 3.42; 95%CI = 1.62–7.23) and MR (OR = 9.34; 95%CI = 3.16–27.59). There was a likely publication bias particularly for MR studies. Conclusion: Our results confirm that BBB disruption is associated with HT in both CT and MR studies. Compared with MR, CT has been more uniformly applied in the literature and has resulted in more consistent results. However, more efforts are needed for harmonization of protocols and methodology for implementation of BBB disruption as a neuroradiological marker in clinical practice.
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Affiliation(s)
| | - Chiara Rinaldi
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Danilo Caimano
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Federica Vit
- NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Enrico Fainardi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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15
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Bernardo-Castro S, Sousa JA, Brás A, Cecília C, Rodrigues B, Almendra L, Machado C, Santo G, Silva F, Ferreira L, Santana I, Sargento-Freitas J. Pathophysiology of Blood-Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery. Front Neurol 2020; 11:594672. [PMID: 33362697 PMCID: PMC7756029 DOI: 10.3389/fneur.2020.594672] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022] Open
Abstract
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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Affiliation(s)
| | - João André Sousa
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Brás
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carla Cecília
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bruno Rodrigues
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Luciano Almendra
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Machado
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gustavo Santo
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fernando Silva
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Ferreira
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - João Sargento-Freitas
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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16
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Weber RZ, Grönnert L, Mulders G, Maurer MA, Tackenberg C, Schwab ME, Rust R. Characterization of the Blood Brain Barrier Disruption in the Photothrombotic Stroke Model. Front Physiol 2020; 11:586226. [PMID: 33262704 PMCID: PMC7688466 DOI: 10.3389/fphys.2020.586226] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022] Open
Abstract
Blood brain barrier (BBB) damage is an important pathophysiological feature of ischemic stroke which significantly contributes to development of severe brain injury and therefore is an interesting target for therapeutic intervention. A popular permanent occlusion model to study long term recovery following stroke is the photothrombotic model, which so far has not been anatomically characterized for BBB leakage beyond the acute phase. Here, we observed enhanced BBB permeability over a time course of 3 weeks in peri-infarct and core regions of the ischemic cortex. Slight increases in BBB permeability could also be seen in the contralesional cortex, hippocampus and the cerebellum at different time points, regions where lesion-induced degeneration of pathways is prominent. Severe damage of tight and adherens junctions and loss of pericytes was observed within the peri-infarct region. Overall, the photothrombotic stroke model reproduces a variety of features observed in human stroke and thus, represents a suitable model to study BBB damage and therapeutic approaches interfering with this process.
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Affiliation(s)
- Rebecca Z Weber
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Lisa Grönnert
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Geertje Mulders
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Michael A Maurer
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Christian Tackenberg
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Martin E Schwab
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Ruslan Rust
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
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17
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Okada T, Suzuki H, Travis ZD, Zhang JH. The Stroke-Induced Blood-Brain Barrier Disruption: Current Progress of Inspection Technique, Mechanism, and Therapeutic Target. Curr Neuropharmacol 2020; 18:1187-1212. [PMID: 32484111 PMCID: PMC7770643 DOI: 10.2174/1570159x18666200528143301] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023] Open
Abstract
Stroke is one of the leading causes of mortality and morbidity worldwide. The blood-brain barrier (BBB) is a characteristic structure of microvessel within the brain. Under normal physiological conditions, the BBB plays a role in the prevention of harmful substances entering into the brain parenchyma within the central nervous system. However, stroke stimuli induce the breakdown of BBB leading to the influx of cytotoxic substances, vasogenic brain edema, and hemorrhagic transformation. Therefore, BBB disruption is a major complication, which needs to be addressed in order to improve clinical outcomes in stroke. In this review, we first discuss the structure and function of the BBB. Next, we discuss the progress of the techniques utilized to study BBB breakdown in in-vitro and in-vivo studies, along with biomarkers and imaging techniques in clinical settings. Lastly, we highlight the mechanisms of stroke-induced neuroinflammation and apoptotic process of endothelial cells causing BBB breakdown, and the potential therapeutic targets to protect BBB integrity after stroke. Secondary products arising from stroke-induced tissue damage provide transformation of myeloid cells such as microglia and macrophages to pro-inflammatory phenotype followed by further BBB disruption via neuroinflammation and apoptosis of endothelial cells. In contrast, these myeloid cells are also polarized to anti-inflammatory phenotype, repairing compromised BBB. Therefore, therapeutic strategies to induce anti-inflammatory phenotypes of the myeloid cells may protect BBB in order to improve clinical outcomes of stroke patients.
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Affiliation(s)
- Takeshi Okada
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA, Risley Hall, Room 219,
11041 Campus St, Loma Linda, CA 92354, USA,Department of Neurosurgery, Mie University Graduate School of Medicine, Mie, Japan, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Mie, Japan, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Zachary D Travis
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA, Risley Hall, Room 219,
11041 Campus St, Loma Linda, CA 92354, USA,Department of Earth and Biological Sciences, Loma Linda University, Loma Linda, CA, USA , Risley Hall, Room 219, 11041 Campus St, Loma Linda, CA 92354, USA
| | - John H Zhang
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA, Risley Hall, Room 219,
11041 Campus St, Loma Linda, CA 92354, USA,Department of Anesthesiology, Loma Linda University, Loma Linda, CA, USA, Risley Hall, Room 219, 11041 Campus St, Loma Linda, CA 92354, USA,Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA, Risley Hall, Room 219, 11041 Campus St, Loma Linda, CA 92354, USA
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18
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Bivard A, Kleinig T, Churilov L, Levi C, Lin L, Cheng X, Chen C, Aviv R, Choi PMC, Spratt NJ, Butcher K, Dong Q, Parsons M. Permeability Measures Predict Hemorrhagic Transformation after Ischemic Stroke. Ann Neurol 2020; 88:466-476. [PMID: 32418242 PMCID: PMC7496077 DOI: 10.1002/ana.25785] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We sought to examine the diagnostic utility of existing predictors of any hemorrhagic transformation (HT) and compare them with new perfusion imaging permeability measures in ischemic stroke patients receiving alteplase only. METHODS A pixel-based analysis of pretreatment CT perfusion (CTP) was undertaken to define the optimal CTP permeability thresholds to predict the likelihood of HT. We then compared previously proposed predictors of HT using regression analyses and receiver operating characteristic curve analysis to produce an area under the curve (AUC). We compared AUCs using χ2 analysis. RESULTS From 5 centers, 1,407 patients were included in this study; of these, 282 had HT. The cohort was split into a derivation cohort (1,025, 70% patients) and a validation cohort (382 patients or 30%). The extraction fraction (E) permeability map at a threshold of 30% relative to contralateral had the highest AUC at predicting any HT (derivation AUC 0.85, 95% confidence interval [CI], 0.79-0.91; validation AUC 0.84, 95% CI 0.77-0.91). The AUC improved when permeability was assessed within the acute perfusion lesion for the E maps at a threshold of 30% (derivation AUC 0.91, 95% CI 0.86-0.95; validation AUC 0.89, 95% CI 0.86-0.95). Previously proposed associations with HT and parenchymal hematoma showed lower AUC values than the permeability measure. INTERPRETATION In this large multicenter study, we have validated a highly accurate measure of HT prediction. This measure might be useful in clinical practice to predict hemorrhagic transformation in ischemic stroke patients before receiving alteplase alone. ANN NEUROL 2020;88:466-476.
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Affiliation(s)
- Andrew Bivard
- Departments of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Christopher Levi
- Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Longting Lin
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Xin Cheng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chushuang Chen
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Richard Aviv
- Department of Radiology, Neuroradiology section, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Philip M C Choi
- Department of Neuroscience, Eastern Health. Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Neil J Spratt
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kenneth Butcher
- Department of Neurology, Department of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mark Parsons
- Departments of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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19
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Suh CH, Jung SC, Cho SJ, Woo DC, Oh WY, Lee JG, Kim KW. MRI for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis. Acta Radiol 2020; 61:964-972. [PMID: 31739673 DOI: 10.1177/0284185119887593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hemorrhagic transformation increases mortality and morbidity in patients with acute ischemic stroke. PURPOSE The purpose of this study is to evaluate the diagnostic performance of magnetic resonance imaging (MRI) for prediction of hemorrhagic transformation in acute ischemic stroke. MATERIAL AND METHODS A systematic literature search of MEDLINE and EMBASE was performed up to 27 July 2018, including the search terms "acute ischemic stroke," "hemorrhagic transformation," and "MRI." Studies evaluating the diagnostic performance of MRI for prediction of hemorrhagic transformation in acute ischemic stroke were included. Diagnostic meta-analysis was conducted with a bivariate random-effects model to calculate the pooled sensitivity and specificity. Subgroup analysis was performed including studies using advanced MRI techniques including perfusion-weighted imaging, diffusion-weighted imaging, and susceptibility-weighted imaging. RESULTS Nine original articles with 665 patients were included. Hemorrhagic transformation is associated with high permeability, hypoperfusion, low apparent diffusion coefficient (ADC), and FLAIR hyperintensity. The pooled sensitivity was 82% (95% confidence interval [CI] 61-93) and the pooled specificity was 79% (95% CI 71-85). The area under the hierarchical summary receiver operating characteristic curve was 0.85 (95% CI 0.82-0.88). Although study heterogeneity was present in both sensitivity (I2=67.96%) and specificity (I2=78.93%), a threshold effect was confirmed. Studies using advanced MRI showed sensitivity of 92% (95% CI 70-98) and specificity of 78% (95% CI 65-87) to conventional MRI. CONCLUSION MRI may show moderate diagnostic performance for predicting hemorrhage in acute ischemic stroke although the clinical significance of this hemorrhage is somewhat uncertain.
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Se Jin Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong-Cheol Woo
- Bioimaging Center, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Woo Yong Oh
- Clinical Research Division, National Institute of Food and Drug Safety Evaluation, MFDS, Cheong Ju, Republic of Korea
| | - Jong Gu Lee
- Clinical Research Division, National Institute of Food and Drug Safety Evaluation, MFDS, Cheong Ju, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
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20
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Cash A, Theus MH. Mechanisms of Blood-Brain Barrier Dysfunction in Traumatic Brain Injury. Int J Mol Sci 2020; 21:ijms21093344. [PMID: 32397302 PMCID: PMC7246537 DOI: 10.3390/ijms21093344] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/16/2022] Open
Abstract
Traumatic brain injuries (TBIs) account for the majority of injury-related deaths in the United States with roughly two million TBIs occurring annually. Due to the spectrum of severity and heterogeneity in TBIs, investigation into the secondary injury is necessary in order to formulate an effective treatment. A mechanical consequence of trauma involves dysregulation of the blood–brain barrier (BBB) which contributes to secondary injury and exposure of peripheral components to the brain parenchyma. Recent studies have shed light on the mechanisms of BBB breakdown in TBI including novel intracellular signaling and cell–cell interactions within the BBB niche. The current review provides an overview of the BBB, novel detection methods for disruption, and the cellular and molecular mechanisms implicated in regulating its stability following TBI.
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Affiliation(s)
- Alison Cash
- The Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA;
| | - Michelle H. Theus
- The Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA;
- The Center for Regenerative Medicine, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
- Correspondence: ; Tel.: 1-540-231-0909; Fax: 1-540-231-7425
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21
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Elsaid N, Mustafa W, Saied A. Radiological predictors of hemorrhagic transformation after acute ischemic stroke: An evidence-based analysis. Neuroradiol J 2020; 33:118-133. [PMID: 31971093 PMCID: PMC7140299 DOI: 10.1177/1971400919900275] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hemorrhagic transformation (HT) is one of the most common adverse events related to acute ischemic stroke (AIS) that affects the treatment plan and clinical outcome. Identification of a sensitive radiological marker may influence the controversial thrombolytic decision in the setting of AIS and may at a minimum indicate more intensive monitoring or further prophylactic interventions. In this article we summarize possible radiological biomarkers and the role of different radiological modalities including computed tomography (CT), magnetic resonance imaging, angiography, and ultrasound in predicting HT. Different radiological indices of early ischemic changes, large ischemic lesion volume, severe blood flow restriction, blood-brain barrier disruption, poor collaterals and high blood flow velocities have been reported to be associated with higher risk of HT. The current levels of evidence of the available studies highlight the role of the different CT perfusion parameters in predicting HT. Further large standardized studies are recommended to compare the sensitivity and specificity of the different radiological markers combined and delineate the most reliable predictor.
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Affiliation(s)
- Nada Elsaid
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
| | - Wessam Mustafa
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
| | - Ahmed Saied
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
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22
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A receptor-binding radiopharmaceutical for imaging of traumatic brain injury in a rodent model: [ 99mTc]Tc-tilmanocept. Nucl Med Biol 2020; 92:107-114. [PMID: 32169304 DOI: 10.1016/j.nucmedbio.2020.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Blood-brain barrier (BBB) disruption and subsequent neuro-inflammation occur following traumatic brain injury (TBI), resulting in a spectrum of human nervous system disorders. [99mTc]Tc-tilmanocept is a receptor-binding radiopharmaceutical FDA-approved for sentinel lymph node mapping. We hypothesize that after an intravenous (i.v.) injection, [99mTc]Tc-tilmanocept, will traverse a disrupted BBB and bind to CD206-bearing microglial cells. METHODS Age-matched mice were divided into three groups: 5-days post TBI (n = 4), and 5-days post sham (n = 4), and naïve controls (n = 4). IRDye800CW-labeled [99mTc]Tc-tilmanocept (0.15 nmol per gram body weight) and FITC-labeled bovine serum albumin (FITC-BSA) were injected (i.v.) into each mouse. Mice were imaged with a high-resolution gamma camera for 45 min. Immediately after imaging, the brains were perfused with fixative, excised, imaged with a fluorescence scanner, assayed for radioactivity, and prepared for histology. RESULTS In vivo nuclear imaging, ex vivo fluorescence imaging, ex vivo gamma well counting, and histo-microscopy demonstrated enhanced tilmanocept uptake in the TBI region. The normalized [99mTc]Tc-tilmanocept uptake value from nuclear imaging and the maximum pixel intensity from fluorescence imaging of the TBI group (1.12 ± 0.12 and 2288 ± 278 a.u., respectively) were significantly (P < 0.04) higher than the sham group (0.64 ± 0.28 and 1708 ± 101 a.u., respectively) and the naive group (0.76 ± 0.24 and 1643 ± 391 a.u., respectively). The mean [99mTc]Tc-tilmanocept scaled uptake in the TBI brains (0.058 ± 0.013%/g) was significantly (P < 0.010) higher than the scaled brain uptake of the sham group (0.031 ± 0.011%/g) and higher (P = 0.04) than the uptake of the naïve group (0.020 ± 0.002%/g). Fluorescence microscopy demonstrated increased uptake of the IRDye800CW-tilmanocept and FITC-BSA in the TBI brain regions. CONCLUSION [99mTc]Tc-tilmanocept traverses disrupted blood-brain barrier and localizes within the injured region. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE: [99mTc]Tc-tilmanocept could serve as an imaging biomarker for TBI-associated neuroinflammation and any disease process that involves a disruption of the blood-brain barrier.
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23
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Basalay MV, Davidson SM, Yellon DM. Neuroprotection in Rats Following Ischaemia-Reperfusion Injury by GLP-1 Analogues-Liraglutide and Semaglutide. Cardiovasc Drugs Ther 2019; 33:661-667. [PMID: 31721014 PMCID: PMC6994526 DOI: 10.1007/s10557-019-06915-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE A substantial number of ischaemic stroke patients who receive reperfusion therapy in the acute phase do not ever fully recover. This reveals the urgent need to develop new adjunctive neuroprotective treatment strategies alongside reperfusion therapy. Previous experimental studies demonstrated the potential of glucagon-like peptide-1 (GLP-1) to reduce acute ischaemic damage in the brain. Here, we examined the neuroprotective effects of two GLP-1 analogues, liraglutide and semaglutide. METHODS A non-diabetic rat model of acute ischaemic stroke involved 90, 120 or 180 min of middle cerebral artery occlusion (MCAO). Liraglutide or semaglutide was administered either i.v. at the onset of reperfusion or s.c. 5 min before the onset of reperfusion. Infarct size and functional status were evaluated after 24 h or 72 h of reperfusion. RESULTS Liraglutide, administered as a bolus at the onset of reperfusion, reduced infarct size by up to 90% and improved neuroscore at 24 h in a dose-dependent manner, following 90-min, but not 120-min or 180-min ischaemia. Semaglutide and liraglutide administered s.c. reduced infarct size by 63% and 48%, respectively, and improved neuroscore at 72 h following 90-min MCAO. Neuroprotection by semaglutide was abolished by GLP1-R antagonist exendin(9-39). CONCLUSION Infarct-limiting and functional neuroprotective effects of liraglutide are dose-dependent. Neuroprotection by semaglutide is at least as strong as by liraglutide and is mediated by GLP-1Rs.
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Affiliation(s)
- Maryna V Basalay
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
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24
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Adebayo OD, Culpan G. Diagnostic accuracy of computed tomography perfusion in the prediction of haemorrhagic transformation and patient outcome in acute ischaemic stroke: A systematic review and meta-analysis. Eur Stroke J 2019; 5:4-16. [PMID: 32232165 DOI: 10.1177/2396987319883461] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/23/2019] [Indexed: 01/23/2023] Open
Abstract
Purpose The aim of this systematic review and meta-analysis is to determine the diagnostic accuracy of computed tomography brain perfusion in the prediction of haemorrhagic transformation and patient outcome in acute ischaemic stroke. Method Electronic databases and grey literature published over the last 10 years related to healthcare and radiology were searched using the key terms: 'computed tomography perfusion', 'haemorrhagic transformation', 'acute ischaemic stroke', 'functional outcome' and their synonyms using both UK and American spellings. Inclusion criteria were: sample size at least 30 patients, original research, evaluate ability of computed tomography perfusion to predict haemorrhagic transformation, reports diagnostic accuracy or provide relevant data for a 2 × 2 contingency table, use follow-up non-contrast computed tomography (NCCT) or magnetic resonance imaging as reference standard. Findings Twelve studies were included in the review; studies cover a total of 808 patients. Haemorrhagic transformation occurred in 30.2% of patients. Pooled sensitivity and specificity were 85.9% (95% CI; 65-97%), 73.9% (95% CI; 45-92%) and accuracy of 79.1% (95% CI; 57-98%). Pooled NPV was 92.9% with a high false positive rate (19.8%), which could be explained in terms of outcome classification, acquisition artefact and computed tomography perfusion processing algorithms. Discussion This review evaluated the importance of using pre-defined threshold measurement for optimal prediction of HT, the relevance of patient pre-treatment clinical parameters to HT occurrence, the CTP parameters and the measurements that are independent predictors of HT, the significance of rtPA rather as an exacerbator of HT and the impact of both minor and major HT/PH on patient 20 functional outcome. Conclusion Computed tomography perfusion has a high sensitivity and moderately high specificity for prediction of haemorrhagic transformation in acute ischaemic stroke. Pre-treatment clinical decision making requires consideration of clinical factors in addition to imaging findings. This systematic review and meta-analysis highlights that pre-treatment computed tomography perfusion adds to clinical confidence by predicting potential for haemorrhage, both in thrombolysed and un-thrombolysed patients, and also influences decisions about alternative treatments for acute ischaemic stroke patients.
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Affiliation(s)
- Olushola D Adebayo
- Mercy University Hospital Cork, Cork, Republic of Ireland
- Faculty of Health Sciences, University of Bradford, Bradford, UK
| | - Gary Culpan
- Faculty of Health Sciences, University of Bradford, Bradford, UK
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25
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Netto JP, Iliff J, Stanimirovic D, Krohn KA, Hamilton B, Varallyay C, Gahramanov S, Daldrup-Link H, d'Esterre C, Zlokovic B, Sair H, Lee Y, Taheri S, Jain R, Panigrahy A, Reich DS, Drewes LR, Castillo M, Neuwelt EA. Neurovascular Unit: Basic and Clinical Imaging with Emphasis on Advantages of Ferumoxytol. Neurosurgery 2019; 82:770-780. [PMID: 28973554 DOI: 10.1093/neuros/nyx357] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/27/2017] [Indexed: 12/11/2022] Open
Abstract
Physiological and pathological processes that increase or decrease the central nervous system's need for nutrients and oxygen via changes in local blood supply act primarily at the level of the neurovascular unit (NVU). The NVU consists of endothelial cells, associated blood-brain barrier tight junctions, basal lamina, pericytes, and parenchymal cells, including astrocytes, neurons, and interneurons. Knowledge of the NVU is essential for interpretation of central nervous system physiology and pathology as revealed by conventional and advanced imaging techniques. This article reviews current strategies for interrogating the NVU, focusing on vascular permeability, blood volume, and functional imaging, as assessed by ferumoxytol an iron oxide nanoparticle.
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Affiliation(s)
- Joao Prola Netto
- Department of Neurology, Oregon Health & Science University, Portland, Oregon.,Department of Neuroradiology, Oregon Health & Science University, Portland, Oregon
| | - Jeffrey Iliff
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Danica Stanimirovic
- Human Health Therapeutics Portfolio, National Research Council of Canada, Ottawa, Ontario, Canada
| | - Kenneth A Krohn
- Department of Radiology, University of Washington, Seattle, Washington.,Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Bronwyn Hamilton
- Department of Neuroradiology, Oregon Health & Science University, Portland, Oregon
| | - Csanad Varallyay
- Department of Neurology, Oregon Health & Science University, Portland, Oregon.,Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Seymur Gahramanov
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico
| | | | - Christopher d'Esterre
- Department of Radiology, University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada
| | - Berislav Zlokovic
- Zikha Neurogenetic Institute, University of Southern California, Los Angeles, California
| | - Haris Sair
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
| | - Yueh Lee
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Saeid Taheri
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Rajan Jain
- Department of Radiology and Neurosurgery, New York University School of Medicine, New York, New York
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel S Reich
- Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Lester R Drewes
- Department of Biomedical Sciences, University of Minnesota, Duluth, Minnesota
| | - Mauricio Castillo
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, Portland, Oregon.,Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon.,Portland Veterans Affairs Medical Center, Portland, Oregon
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26
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Suh CH, Jung SC, Cho SJ, Kim D, Lee JB, Woo DC, Oh WY, Lee JG, Kim KW. Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis. Eur Radiol 2019; 29:4077-4087. [PMID: 30617485 DOI: 10.1007/s00330-018-5936-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/13/2018] [Accepted: 11/29/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the diagnostic performance of perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke. METHODS A computerized literature search of Ovid MEDLINE and EMBASE was conducted up to October 29, 2018. Search terms included acute ischemic stroke, hemorrhagic transformation, and perfusion CT. Studies assessing the diagnostic performance of perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke were included. Two reviewers independently evaluated the eligibility of the studies. A bivariate random effects model was used to calculate the pooled sensitivity and pooled specificity. Multiple subgroup analyses were performed. RESULTS Fifteen original articles with a total of 1134 patients were included. High blood-brain barrier permeability and hypoperfusion status derived from perfusion CT are associated with hemorrhagic transformation. The pooled sensitivity and specificity were 84% (95% CI, 71-91%) and 74% (95% CI, 67-81%), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.84 (95% CI, 0.81-0.87). The Higgins I2 statistic demonstrated that heterogeneity was present in the sensitivity (I2 = 80.21%) and specificity (I2 = 85.94%). CONCLUSION Although various perfusion CT parameters have been used across studies, the current evidence supports the use of perfusion CT to predict hemorrhagic transformation in acute ischemic stroke. KEY POINTS • High blood-brain barrier permeability and hypoperfusion status derived from perfusion CT were associated with hemorrhagic transformation. • Perfusion CT has moderate diagnostic performance for the prediction of hemorrhagic transformation in acute ischemic stroke. • The pooled sensitivity was 84%, and the pooled specificity was 74%.
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Se Jin Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Donghyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jung Bin Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Dong-Cheol Woo
- Bioimaging Center, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Woo Yong Oh
- Clinical Research Division, National Institute of Food and Drug Safety Evaluation, MFDS, Cheongju, Republic of Korea
| | - Jong Gu Lee
- Clinical Research Division, National Institute of Food and Drug Safety Evaluation, MFDS, Cheongju, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.,Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
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27
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Kalinin MN, Khasanova DR, Ibatullin MM. A comprehensive assessment of brain perfusion data in patients with acute ischemic stroke for prediction of hemorrhagic transformation. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:24-36. [DOI: 10.17116/jnevro201911903224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lu D, Liu Y, Mai H, Zang J, Shen L, Zhang Y, Xu A. Rosuvastatin Reduces Neuroinflammation in the Hemorrhagic Transformation After rt-PA Treatment in a Mouse Model of Experimental Stroke. Front Cell Neurosci 2018; 12:225. [PMID: 30116175 PMCID: PMC6082938 DOI: 10.3389/fncel.2018.00225] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/11/2018] [Indexed: 12/31/2022] Open
Abstract
Hemorrhagic transformation (HT) is a serious complication that stimulates inflammation during reperfusion therapy after acute ischemic stroke. Rosuvastatin, a 3-hydroxymethyl-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, might improve the outcome of HT by inhibiting neuroinflammation. This study aimed to explore the protective effects of rosuvastatin against HT after recombinant tissue plasminogen activator (rt-PA) treatment in mice with experimental stroke via the attenuation of inflammation. A total of one hundred sixty-nine male BALB/c mice were used in the experiment. HT was successfully established in 70 mice that were subjected to 3 h of middle cerebral artery occlusion (MCAO) followed by a 10 mg/kg rt-PA injection over 10 min and reperfusion for 24 h. The mice were then administered rosuvastatin (1 mg/kg, 5 mg/kg) or saline (vehicle). The brain water content and neurological deficits (wire hang and adhesive removal somatosensory tests) were assessed at 24 h after rt-PA reperfusion following MCAO surgery. The morphology, blood-brain barrier (BBB) permeability and number of astrocytes and microglia were assessed by immunohistochemistry, electron microscopy and western blotting at 24 h after rt-PA reperfusion following MCAO surgery. Rosuvastatin protected against impaired neurological function and reversed the BBB leakage observed in the HT group. The increased activation of astrocytes and microglia and secretion of inflammatory factors caused by HT damage were significantly attenuated by high-dose rosuvastatin treatment vs. normal-dose rosuvastatin treatment. Related inflammatory pathways, such as the nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) pathways, were downregulated in the rosuvastatin-treated groups compared with the HT group. In conclusion, our results indicate that rosuvastatin is a promising therapeutic agent for HT after rt-PA reperfusion following MCAO surgery in mice, as it attenuates neuroinflammation. Additionally, high-dose rosuvastatin treatment could have a greater anti-inflammatory effect on HT than normal-dose rosuvastatin treatment.
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Affiliation(s)
- Dan Lu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Clinical Neuroscience Institute of Jinan University, Guangzhou, China
| | - Yanfang Liu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Clinical Neuroscience Institute of Jinan University, Guangzhou, China
| | - Hongcheng Mai
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Clinical Neuroscience Institute of Jinan University, Guangzhou, China
| | - Jiankun Zang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Clinical Neuroscience Institute of Jinan University, Guangzhou, China
| | - Lingling Shen
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Clinical Neuroscience Institute of Jinan University, Guangzhou, China
| | - Yusheng Zhang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Anding Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Clinical Neuroscience Institute of Jinan University, Guangzhou, China
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29
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Ni Y, Alwell K, Moomaw CJ, Woo D, Adeoye O, Flaherty ML, Ferioli S, Mackey J, De Los Rios La Rosa F, Martini S, Khatri P, Kleindorfer D, Kissela BM. Towards phenotyping stroke: Leveraging data from a large-scale epidemiological study to detect stroke diagnosis. PLoS One 2018; 13:e0192586. [PMID: 29444182 PMCID: PMC5812624 DOI: 10.1371/journal.pone.0192586] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/26/2018] [Indexed: 01/30/2023] Open
Abstract
Objective 1) To develop a machine learning approach for detecting stroke cases and subtypes from hospitalization data, 2) to assess algorithm performance and predictors on real-world data collected by a large-scale epidemiology study in the US; and 3) to identify directions for future development of high-precision stroke phenotypic signatures. Materials and methods We utilized 8,131 hospitalization events (ICD-9 codes 430–438) collected from the Greater Cincinnati/Northern Kentucky Stroke Study in 2005 and 2010. Detailed information from patients’ medical records was abstracted for each event by trained research nurses. By analyzing the broad list of demographic and clinical variables, the machine learning algorithms predicted whether an event was a stroke case and, if so, the stroke subtype. The performance was validated on gold-standard labels adjudicated by stroke physicians, and results were compared with stroke classifications based on ICD-9 discharge codes, as well as labels determined by study nurses. Results The best performing machine learning algorithm achieved a performance of 88.57%/93.81%/92.80%/93.30%/89.84%/98.01% (accuracy/precision/recall/F-measure/area under ROC curve/area under precision-recall curve) on stroke case detection. For detecting stroke subtypes, the algorithm yielded an overall accuracy of 87.39% and greater than 85% precision on individual subtypes. The machine learning algorithms significantly outperformed the ICD-9 method on all measures (P value<0.001). Their performance was comparable to that of study nurses, with better tradeoff between precision and recall. The feature selection uncovered a subset of predictive variables that could facilitate future development of effective stroke phenotyping algorithms. Discussion and conclusions By analyzing a broad array of patient data, the machine learning technologies held promise for improving detection of stroke diagnosis, thus unlocking high statistical power for subsequent genetic and genomic studies.
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Affiliation(s)
- Yizhao Ni
- Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Kathleen Alwell
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Charles J. Moomaw
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Opeolu Adeoye
- Department of Emergency Medicine and Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Matthew L. Flaherty
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Simona Ferioli
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Jason Mackey
- Department of Neurology, Indiana University, Indianapolis, Indiana, United States of America
| | | | - Sharyl Martini
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Dawn Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Brett M. Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
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Horsch AD, Bennink E, van Seeters T, Kappelle LJ, van der Graaf Y, Mali WPTM, de Jong HWAM, Velthuis BK, Dankbaar JW. Computed Tomography Perfusion Derived Blood-Brain Barrier Permeability Does Not Yet Improve Prediction of Hemorrhagic Transformation. Cerebrovasc Dis 2018; 45:26-32. [PMID: 29402765 DOI: 10.1159/000485043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 11/03/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Hemorrhagic transformation (HT) in acute ischemic stroke can occur as a result of reperfusion treatment. While withholding treatment may be warranted in patients with increased risk of HT, prediction of HT remains difficult. Nonlinear regression analysis can be used to estimate blood-brain barrier permeability (BBBP). The aim of this study was to identify a combination of clinical and imaging variables, including BBBP estimations, that can predict HT. MATERIALS AND METHODS From the Dutch acute stroke study, 545 patients treated with intravenous recombinant tissue plasminogen activator and/or intra-arterial treatment were selected, with available admission extended computed tomography (CT) perfusion and follow-up imaging. Patient admission treatment characteristics and CT imaging parameters regarding occlusion site, stroke severity, and BBBP were recorded. HT was assessed on day 3 follow-up imaging. The association between potential predictors and HT was analyzed using univariate and multivariate logistic regression. To compare the added value of BBBP, areas under the curve (AUCs) were created from 2 models, with and without BBBP. RESULTS HT occurred in 57 patients (10%). In univariate analysis, older age (OR 1.03, 95% CI 1.006-1.05), higher admission National Institutes of Health Stroke Scale (NIHSS; OR 1.13, 95% CI 1.08-1.18), higher clot burden (OR 1.28, 95% CI 1.16-1.41), poor collateral score (OR 3.49, 95% CI 1.85-6.58), larger Alberta Stroke Program Early CT Score cerebral blood volume deficit size (OR 1.26, 95% CI 1.14-1.38), and increased BBBP (OR 2.22, 95% CI 1.46-3.37) were associated with HT. In multivariate analysis with age and admission NIHSS, the addition of BBBP did not improve the AUC compared to both independent predictors alone (AUC 0.77, 95% CI 0.71-0.83). CONCLUSION BBBP predicts HT but does not improve prediction with age and admission NIHSS.
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Affiliation(s)
- Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom van Seeters
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Liu Y, Zhang M, Chen Y, Gao P, Yun W, Zhou X. The degree of leukoaraiosis predicts clinical outcomes and prognosis in patients with middle cerebral artery occlusion after intravenous thrombolysis. Brain Res 2017; 1681:28-33. [PMID: 29288062 DOI: 10.1016/j.brainres.2017.12.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
Leukoaraiosis (LA) is common in elderly patients with ischemic stroke on magnetic resonance imaging. In this study, we investigate whether the degree of LA is associated with clinical outcomes and prognosis of patients with middle cerebral artery occlusion following intravenous thrombolytic. Ninety-seven patients were recruited and divided into three groups based on the degree of LA (no, mild and moderate to severe LA) by the Fazekas scale. Clinical outcomes, recurrent stroke, Fugl-Meyer rating scale (FMS) and complications of intravenous thrombolysis were assessed. The association between the degree of LA and functional outcomes was analyzed by multivariable logistic regression model. Patients enrolled were divided into three groups: 26 patients with no LA, 43 patients with mild LA and 28 patients with moderate to severe LA. Impressively, the patients with mild LA were better in early neurological recovery and 90-day FMS score than patients in the other two groups. Multivariate logistic analysis revealed that moderate to severe LA was an independent predictor of poor functional outcome (OR: 10.482; 95% CI: 1.442-76.181; P = .020). Moreover, the patients with moderate to severe LA have a higher rate of hemorrhagic transformation and recurrent stroke as compared with two other groups during 90-day follow-up. Different degrees of LA differentially affect clinical outcome and prognosis in patients with middle cerebral artery occlusion following intravenous thrombolytic. Moderate to severe LA is a risk factor of poor prognosis. Mild LA is associated with early neurological recovery and good motor functional outcome.
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Affiliation(s)
- Yanyan Liu
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Min Zhang
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Yuan Chen
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Ping Gao
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Wenwei Yun
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China.
| | - Xianju Zhou
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China.
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Yu Y, Guo D, Lou M, Liebeskind D, Scalzo F. Prediction of Hemorrhagic Transformation Severity in Acute Stroke From Source Perfusion MRI. IEEE Trans Biomed Eng 2017; 65:2058-2065. [PMID: 29989941 DOI: 10.1109/tbme.2017.2783241] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Hemorrhagic transformation (HT) is the most severe complication of reperfusion therapy in acute ischemic stroke (AIS) patients. Management of AIS patients could benefit from accurate prediction of upcoming HT. While prediction of HT occurrence has recently provided encouraging results, the prediction of the severity and territory of the HT could bring valuable insights that are beyond current methods. METHODS This study tackles these issues and aims to predict the spatial occurrence of HT in AIS from perfusion-weighted magnetic resonance imaging (PWI) combined with diffusion weighted imaging. In all, 165 patients were included in this study and analyzed retrospectively from a cohort of AIS patients treated with reperfusion therapy in a single stroke center. RESULTS Machine learning models are compared within our framework; support vector machines, linear regression, decision trees, neural networks, and kernel spectral regression were applied to the dataset. Kernel spectral regression performed best with an accuracy of $\text{83.7} \pm \text{2.6}\%$. CONCLUSION The key contribution of our framework formalize HT prediction as a machine learning problem. Specifically, the model learns to extract imaging markers of HT directly from source PWI images rather than from pre-established metrics. SIGNIFICANCE Predictions visualized in terms of spatial likelihood of HT in various territories of the brain were evaluated against follow-up gradient recalled echo and provide novel insights for neurointerventionalists prior to endovascular therapy.
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High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke. PLoS One 2017; 12:e0188238. [PMID: 29182658 PMCID: PMC5705117 DOI: 10.1371/journal.pone.0188238] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/05/2017] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Blood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain. We aimed to determine the performance of high-permeability region size on PCT (HPrs-PCT) in predicting HT after intravenous tPA administration in patients with acute stroke. METHODS We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4.5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT. RESULTS The study included 156 patients (50% male, median age 75.5 years). Thirty-seven (23,7%) developed HT [12 (7,7%), parenchymal hematoma type 2 (PH-2)]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes, larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0.84 for HT and 0.93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0.77). HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0.68, p = 0.045). CONCLUSIONS HPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HT.
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Li Y, Xia Y, Chen H, Liu N, Jackson A, Wintermark M, Zhang Y, Hu J, Wu B, Zhang W, Tu J, Su Z, Zhu G. Focal Low and Global High Permeability Predict the Possibility, Risk, and Location of Hemorrhagic Transformation following Intra-Arterial Thrombolysis Therapy in Acute Stroke. AJNR Am J Neuroradiol 2017; 38:1730-1736. [PMID: 28705822 DOI: 10.3174/ajnr.a5287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 05/06/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The contrast volume transfer coefficient (Ktrans), which reflects blood-brain barrier permeability, is influenced by circulation and measurement conditions. We hypothesized that focal low BBB permeability values can predict the spatial distribution of hemorrhagic transformation and global high BBB permeability values can predict the likelihood of hemorrhagic transformation. MATERIALS AND METHODS We retrospectively enrolled 106 patients with hemispheric stroke who received intra-arterial thrombolytic treatment. Ktrans maps were obtained with first-pass perfusion CT data. The Ktrans values at the region level, obtained with the Alberta Stroke Program Early CT Score system, were compared to determine the differences between the hemorrhagic transformation and nonhemorrhagic transformation regions. The Ktrans values of the whole ischemic region based on baseline perfusion CT were obtained as a variable to hemorrhagic transformation possibility at the global level. RESULTS Forty-eight (45.3%) patients had hemorrhagic transformation, and 21 (19.8%) had symptomatic intracranial hemorrhage. At the region level, there were 82 ROIs with hemorrhagic transformation and parenchymal hemorrhage with a mean Ktrans, 0.5 ± 0.5/min, which was significantly lower than that in the nonhemorrhagic transformation regions (P < .01). The mean Ktrans value of 615 nonhemorrhagic transformation ROIs was 0.7 ± 0.6/min. At the global level, there was a significant difference (P = .01) between the mean Ktrans values of patients with symptomatic intracranial hemorrhage (1.3 ± 0.9) and those without symptomatic intracranial hemorrhage (0.8 ± 0.4). Only a high Ktrans value at the global level could predict the occurrence of symptomatic intracranial hemorrhage (P < .01; OR = 5.04; 95% CI, 2.01-12.65). CONCLUSIONS Global high Ktrans values can predict the likelihood of hemorrhagic transformation or symptomatic intracranial hemorrhage at the patient level, whereas focal low Ktrans values can predict the spatial distributions of hemorrhagic transformation at the region level.
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Affiliation(s)
- Y Li
- From the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
- Department of Radiology (Y.L., M.W.), Neuroradiology Section, Stanford University, Stanford, California
| | - Y Xia
- Department of Critical Care Medicine (Y.X.), Yantai Yuhuangding Hospital, Shandong, China
| | - H Chen
- From the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
| | - N Liu
- From the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
| | - A Jackson
- Wolfson Molecular Imaging Centre (A.J.), University of Manchester, Manchester, UK
| | - M Wintermark
- Department of Radiology (Y.L., M.W.), Neuroradiology Section, Stanford University, Stanford, California
| | - Y Zhang
- Department of Neurology (Y.Z.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | - J Hu
- Department of Neurology (J.H., G.Z.), Southwest Hospital, Third Military Medical University, Chongqing, China
| | - B Wu
- Department of Radiology (B.W.), PLA Army General Hospital, Beijing, China
| | - W Zhang
- From the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
| | - J Tu
- Outpatient Department (J.T.), PLA 61889 Army, Beijing, China
| | - Z Su
- GE Healthcare (Z.S.), Beijing, China.
| | - G Zhu
- Department of Neurology (J.H., G.Z.), Southwest Hospital, Third Military Medical University, Chongqing, China
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Li Q, Gao X, Yao Z, Feng X, He H, Xue J, Gao P, Yang L, Cheng X, Chen W, Yang Y. Permeability Surface of Deep Middle Cerebral Artery Territory on Computed Tomographic Perfusion Predicts Hemorrhagic Transformation After Stroke. Stroke 2017; 48:2412-2418. [PMID: 28775139 DOI: 10.1161/strokeaha.117.017486] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/22/2017] [Accepted: 07/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Permeability surface (PS) on computed tomographic perfusion reflects blood-brain barrier permeability and is related to hemorrhagic transformation (HT). HT of deep middle cerebral artery (MCA) territory can occur after recanalization of proximal large-vessel occlusion. We aimed to determine the relationship between HT and PS of deep MCA territory. METHODS We retrospectively reviewed 70 consecutive acute ischemic stroke patients presenting with occlusion of the distal internal carotid artery or M1 segment of the MCA. All patients underwent computed tomographic perfusion within 6 hours after symptom onset. Computed tomographic perfusion data were postprocessed to generate maps of different perfusion parameters. Risk factors were identified for increased deep MCA territory PS. Receiver operating characteristic curve analysis was performed to calculate the optimal PS threshold to predict HT of deep MCA territory. RESULTS Increased PS was associated with HT of deep MCA territory. After adjustments for age, sex, onset time to computed tomographic perfusion, and baseline National Institutes of Health Stroke Scale, poor collateral status (odds ratio, 7.8; 95% confidence interval, 1.67-37.14; P=0.009) and proximal MCA-M1 occlusion (odds ratio, 4.12; 95% confidence interval, 1.03-16.52; P=0.045) were independently associated with increased deep MCA territory PS. Relative PS most accurately predicted HT of deep MCA territory (area under curve, 0.94; optimal threshold, 2.89). CONCLUSIONS Increased PS can predict HT of deep MCA territory after recanalization therapy for cerebral proximal large-vessel occlusion. Proximal MCA-M1 complete occlusion and distal internal carotid artery occlusion in conjunction with poor collaterals elevate deep MCA territory PS.
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Affiliation(s)
- Qiao Li
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
| | - Xinyi Gao
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
| | - Zhenwei Yao
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
| | - Xiaoyuan Feng
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
| | - Huijin He
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.).
| | - Jing Xue
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
| | - Peiyi Gao
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
| | - Lumeng Yang
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
| | - Xin Cheng
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
| | - Weijian Chen
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
| | - Yunjun Yang
- From the Departments of Radiology (Q.L., X.G., Z.Y., X.F., H.H.) and Neurology (L.Y., X.C.), Huashan Hospital, Fudan University, Shanghai, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.X., P.G.); Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, China (W.C., Y.Y.)
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Yeo LLL, Tan BYQ, Andersson T. Review of Post Ischemic Stroke Imaging and Its Clinical Relevance. Eur J Radiol 2017; 96:145-152. [PMID: 28237773 DOI: 10.1016/j.ejrad.2017.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
In this day and age, multiple imaging modalities are available to the stroke physician in the post-treatment phase.The practical challenge for physicians who treat stroke is to evaluate the pros and cons of each technique and select the best choice for the situation. The choice of imaging modality remains contentious at best and varies among different institutions and centres. This is no simple task an there are many factors to consider, including the differential diagnosis which need to be evaluated, the availability and reliability of the imaging technique and time and expertise required to perform and interpret the scanning. Other ancillary competing interest also come into play such as the financial cost of the modality, the requirement for patient monitoring during the imaging procedure and patient comfort. In an effort to clear some of the ambiguity surrounding this topic we present some of the current techniques in use and others, which are still in the realm of research and have not yet transitioned into clinical practice.
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Affiliation(s)
- Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
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Ji B, Zhou F, Han L, Yang J, Fan H, Li S, Li J, Zhang X, Wang X, Chen X, Xu Y. Sodium Tanshinone IIA Sulfonate Enhances Effectiveness Rt-PA Treatment in Acute Ischemic Stroke Patients Associated with Ameliorating Blood-Brain Barrier Damage. Transl Stroke Res 2017; 8:334-340. [PMID: 28243834 PMCID: PMC5493726 DOI: 10.1007/s12975-017-0526-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/11/2017] [Accepted: 02/13/2017] [Indexed: 12/11/2022]
Abstract
Treatment with sodium tanshinone IIA sulfonate (STS) may ameliorate blood-brain barrier (BBB) damage in acute ischemic stroke patients receiving recombinant tissue plasminogen activator (rt-PA) thrombolysis and improve stroke patients’ outcome. This randomized, single-center, placebo-controlled clinical trial investigated the potential effects and underlying mechanisms of STS. Forty-two acute ischemic stroke patients receiving intravenous rt-PA thrombolysis were randomized to intravenous administration either with STS (60 mg/day) (n = 21) or with equivalent volume of saline as a placebo (n = 21) after randomization for 10 days. Clinical outcomes, computer tomography perfusion (CTP) imaging with permeability-surface area product (PS) maps and serum levels of BBB damage biomarkers, were compared between the two groups. The percentage of patients with excellent functional outcome indicated by a 90-day mRS ≤1 was significantly higher in the STS group than in the placebo group (p = 0.028). For patients with CTP imaging (n = 30), PS in the ipsilateral lesion (p = 0.034) and relative PS (p = 0.013) were significantly lower in the STS group than that in placebo. STS-treated patients also had lower levels of matrix metalloproteinase (MMP)-9 (p = 0.036) and claudin-5 (p = 0.026), but higher levels of tissue inhibitor of metalloproteinase (TIMP)-1 (p = 0.040) than those in the placebo group. Post-stroke STS treatment could improve neurologic functional outcomes for acute ischemic stroke patients following rt-PA treatment by reducing BBB leakage and damage, which might be mechanistically associated with MMP-9 inhibition.
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Affiliation(s)
- Biying Ji
- Department of Neurology and Radiology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology and Jiangsu Key Laboratory for Molecular Medicine of Nanjing University, Nanjing, People's Republic of China
| | - Fei Zhou
- Department of Neurology and Radiology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology and Jiangsu Key Laboratory for Molecular Medicine of Nanjing University, Nanjing, People's Republic of China
| | - Lijuan Han
- Department of Neurology and Radiology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology and Jiangsu Key Laboratory for Molecular Medicine of Nanjing University, Nanjing, People's Republic of China
| | - Jun Yang
- GE Healthcare, Shanghai, People's Republic of China
| | - Haijian Fan
- Department of Neurology and Radiology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology and Jiangsu Key Laboratory for Molecular Medicine of Nanjing University, Nanjing, People's Republic of China
| | - Shanshan Li
- Department of Neurology and Radiology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology and Jiangsu Key Laboratory for Molecular Medicine of Nanjing University, Nanjing, People's Republic of China
| | - Jingwei Li
- Department of Neurology and Radiology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology and Jiangsu Key Laboratory for Molecular Medicine of Nanjing University, Nanjing, People's Republic of China
| | - Xin Zhang
- Department of Neurology and Radiology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology and Jiangsu Key Laboratory for Molecular Medicine of Nanjing University, Nanjing, People's Republic of China
| | - Xiaoying Wang
- Departments of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Xiangyan Chen
- Departments of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Yun Xu
- Department of Neurology and Radiology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology and Jiangsu Key Laboratory for Molecular Medicine of Nanjing University, Nanjing, People's Republic of China.
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Wei XE, Zhou J, Li WB, Zhao YW, Li MH, Li YH. MRI based thrombolysis for FLAIR-negative stroke patients within 4.5-6h after symptom onset. J Neurol Sci 2016; 372:421-427. [PMID: 27839719 DOI: 10.1016/j.jns.2016.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
To investigate the feasibility of DWI-FLAIR mismatch in identifying patients who might benefit from thrombolytic therapy within 4.5-6h, we analyzed the data of 105 ischemic stroke patients with known time of symptom onset who underwent MRI within 6h of stroke and thrombolysis between December 2006 and December 2013. They were divided into three groups: symptom onset within 4.5h (n=66); 4.5-6h and FLAIR images negative (n=9); and 4.5-6h and FLAIR images positive (n=30). Outcome of thrombolysis was assessed for each group by recanalization rate, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores. The results showed that mismatch between positive DWI and negative FLAIR images identified patients within 4.5h of symptom onset with sensitivity, specificity, positive predictive value and negative predictive value of 40.9%, 76.9%, and 75% and 43.5%. Recanalization rate, NIHSS score and mRS score were all better in both the 0-4.5h and 4.5-6h FLAIR-negative groups than in the 4.5-6h FLAIR-positive group (p<0.05). These data demonstrate that within 4.5-6h of symptom onset, patients with negative FLAIR images may benefit from thrombolysis therapy.
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Affiliation(s)
- Xiao-Er Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Jia Zhou
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Wen-Bin Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Yu-Wu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Ming-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Yue-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China.
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Chen F, Wang W, Ding H, Yang Q, Dong Q, Cui M. The glucagon-like peptide-1 receptor agonist exendin-4 ameliorates warfarin-associated hemorrhagic transformation after cerebral ischemia. J Neuroinflammation 2016; 13:204. [PMID: 27566245 PMCID: PMC5002167 DOI: 10.1186/s12974-016-0661-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 07/14/2016] [Indexed: 12/25/2022] Open
Abstract
Background As the number of patients with cardioembolic ischemic stroke is predicted to be double by 2030, increased burden of warfarin-associated hemorrhagic transformation (HT) after cerebral ischemia is an expected consequence. However, thus far, no effective treatment strategy is available for HT prevention in routine clinical practice. While the glucagon-like peptide-1 receptor (GLP-1R) agonist exendin-4 (Ex-4) is known to protect against oxidative stress and neuronal cell death caused by ischemic brain damage, its effect on preventing warfarin-associated HT after cerebral ischemia is yet unknown. Therefore, we hypothesized that Ex-4 would stabilize the blood-brain barrier (BBB) and suppress neuroinflammation through PI3K-Akt-induced inhibition of glycogen synthase kinase-3β (GSK-3β) after warfarin-associated HT post-cerebral ischemia. Methods We used male C57BL/6 mice for all experiments. A 5-mg warfarin sodium tablet was dissolved in animals’ drinking water (effective warfarin uptake 0.04 mg (2 mg/kg) per mouse). The mice were fed for 0, 6, 12, and 24 h with ad libitum access to the treated water. To study the effects of Ex-4, temporary middle cerebral artery occlusion (MCAO) was performed. Then, either Ex-4 (10 mg/kg) or saline was injected through the tail vein, and in the Ex-4 + wortmannin group, PI3K inhibitor wortmannin was intravenously injected, after reperfusion. The infarct volume, neurological deficits, and integrity of the BBB were assessed 72 h post MCAO. One- or two-way ANOVA was used to test the difference between means followed by Newman–Keuls post hoc testing for pair-wise comparison. Results We observed that Ex-4 ameliorated warfarin-associated HT and preserved the integrity of the BBB after cerebral ischemia through the PI3K/Akt/GSK-3β pathway. Furthermore, Ex-4 suppressed oxidative DNA damage and lipid peroxidation, attenuated pro-inflammatory cytokine expression levels, and suppressed microglial activation and neutrophil infiltration in warfarin-associated HT post-cerebral ischemia. However, these effects were totally abolished in the mice treated with Ex-4 + the PI3K inhibitor—wortmannin. The PI3K/Akt-GSK-3β signaling pathway appeared to contribute to the protection afforded by Ex-4 in the warfarin-associated HT model. Conclusions GLP-1 administration could reduce warfarin-associated HT in mice. This beneficial effect of GLP-1 is associated with attenuating neuroinflammation and BBB disruption by inactivating GSK-3β through the PI3K/Akt pathway. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0661-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fangzhe Chen
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Weifeng Wang
- The Department of Clinical Laboratory, Central Laboratory, Jing'an District Centre Hospital of Shanghai, Huashan Hospital Fudan University Jing'an Branch, No. 259 Xi Kang Road, Shanghai, 200040, China
| | - Hongyan Ding
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Qi Yang
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Mei Cui
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.
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Wang Q, Duan F, Wang MX, Wang XD, Liu P, Ma LZ. Effect of stem cell-based therapy for ischemic stroke treatment: A meta-analysis. Clin Neurol Neurosurg 2016; 146:1-11. [DOI: 10.1016/j.clineuro.2016.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 01/01/2023]
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Chen H, Liu N, Li Y, Wintermark M, Jackson A, Wu B, Su Z, Chen F, Hu J, Zhang Y, Zhu G. Mismatch of Low Perfusion and High Permeability Predicts Hemorrhagic Transformation Region in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolysis. Sci Rep 2016; 6:27950. [PMID: 27302077 PMCID: PMC4908417 DOI: 10.1038/srep27950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/27/2016] [Indexed: 01/20/2023] Open
Abstract
This study sought to determine whether the permeability related parameter K(trans), derived from computed tomography perfusion (CTP) imaging, can predict hemorrhagic transformation (HT) in patients with acute ischemic stroke who receive intra-arterial thrombolysis. Data from patients meeting the criterion were examined. CTP was performed and K(trans) maps were used to assess the permeability values in HT and non-HT regions. A receiver operating characteristic (ROC) curve was calculated, showing the sensitivity and specificity of K(trans) for predicting HT risk. Composite images were produced to illustrate the spatial correlations among perfusion, permeability changes and HT. This study examined 41 patients. Twenty-six patients had hemorrhagic infarction and 15 had parenchymal hemorrhage. The mean K(trans) value in HT regions was significantly lower than that in the non-HT regions (0.26 ± 0.21/min vs. 0.78 ± 0.64/min; P < 0.001). The ROC curve analysis identified an optimal cutoff value of 0.334/min for K(trans) to predict HT risk. Composite images suggested ischemic regions with low permeability, or the mismatch area of low perfusion and high permeability, more likely have HT. HT regions after intra-arterial thrombolysis had lower permeability values on K(trans) maps. The mismatch area of lower perfusion and higher permeability are more likely to develop HT.
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Affiliation(s)
- Hui Chen
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | - Nan Liu
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | - Ying Li
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | - Max Wintermark
- Stanford University, Department of Radiology, Neuroradiology Section, Stanford, CA, USA
| | - Alan Jackson
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Bing Wu
- Department of Radiology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | | | - Fei Chen
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | - Jun Hu
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Yongwei Zhang
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Guangming Zhu
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
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Ivanidze J, Kallas ON, Gupta A, Weidman E, Baradaran H, Mir D, Giambrone A, Segal AZ, Claassen J, Sanelli PC. Application of Blood-Brain Barrier Permeability Imaging in Global Cerebral Edema. AJNR Am J Neuroradiol 2016; 37:1599-603. [PMID: 27127002 DOI: 10.3174/ajnr.a4784] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 02/22/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Blood-brain barrier permeability is not routinely evaluated in the clinical setting. Global cerebral edema occurs after SAH and is associated with BBB disruption. Detection of global cerebral edema using current imaging techniques is challenging. Our purpose was to apply blood-brain barrier permeability imaging in patients with global cerebral edema by using extended CT perfusion. MATERIALS AND METHODS Patients with SAH underwent CTP in the early phase after aneurysmal rupture (days 0-3) and were classified as having global cerebral edema or nonglobal cerebral edema using established noncontrast CT criteria. CTP data were postprocessed into blood-brain barrier permeability quantitative maps of PS (permeability surface-area product), K(trans) (volume transfer constant from blood plasma to extravascular extracellular space), Kep (washout rate constant of the contrast agent from extravascular extracellular space to intravascular space), VE (extravascular extracellular space volume per unit of tissue volume), VP (plasmatic volume per unit of tissue volume), and F (plasma flow) by using Olea Sphere software. Mean values were compared using t tests. RESULTS Twenty-two patients were included in the analysis. Kep (1.32 versus 1.52, P < .0001), K(trans) (0.15 versus 0.19, P < .0001), VP (0.51 versus 0.57, P = .0007), and F (1176 versus 1329, P = .0001) were decreased in global cerebral edema compared with nonglobal cerebral edema while VE (0.81 versus 0.39, P < .0001) was increased. CONCLUSIONS Extended CTP was used to evaluate blood-brain barrier permeability in patients with SAH with and without global cerebral edema. Kep is an important indicator of altered blood-brain barrier permeability in patients with decreased blood flow, as Kep is flow-independent. Further study of blood-brain barrier permeability is needed to improve diagnosis and monitoring of global cerebral edema.
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Affiliation(s)
- J Ivanidze
- From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.)
| | - O N Kallas
- From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.)
| | - A Gupta
- From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.)
| | - E Weidman
- From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.)
| | - H Baradaran
- From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.)
| | - D Mir
- From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.)
| | - A Giambrone
- Healthcare Policy and Research (A.Giambrone)
| | - A Z Segal
- Neurology (A.Z.S.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - J Claassen
- Department of Neurology (J.C.), New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - P C Sanelli
- From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.)
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Garrigue P, Giacomino L, Bucci C, Muzio V, Filannino MA, Sabatier F, Dignat-George F, Pisano P, Guillet B. Single photon emission computed tomography imaging of cerebral blood flow, blood–brain barrier disruption, and apoptosis time course after focal cerebral ischemia in rats. Int J Stroke 2015; 11:117-26. [DOI: 10.1177/1747493015607516] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Cerebral ischemia is a leading cause of disability worldwide and no other effective therapy has been validated to date than intravenous thrombolysis. In this context, many preclinical models have been developed and recent advances in preclinical imaging represent promising tools. Thus, we proposed here to characterize in vivo time profiles of cerebral blood flow, blood–brain barrier disruption and apoptosis following a transient middle cerebral artery occlusion in rats using SPECT/CT imaging. Methods Rats underwent a 1-h middle cerebral artery occlusion followed by reperfusion. Cerebral blood flow, blood–brain barrier disruption and apoptosis were evaluated by SPECT/CT imaging using respectively 99mTc-HMPAO, 99mTc-DTPA and the experimental 99mTc-Annexin V-128, up to 14 days after middle cerebral artery occlusion. Histological evaluation of apoptosis has been performed using TUNEL method to validate the 99mTc-Annexin V-128 uptake. Results 99mTc-HMPAO cerebral blood flow evaluation showed hypoperfusion during occlusion, partially restored on days 4 and 7 and sustained up to 14 days after middle cerebral artery occlusion. 99mTc-DTPA SPECT/CT showed a blood–brain barrier disruption starting on day 1 post-middle cerebral artery occlusion, peaking on day 2, with barrier integrity totally restored on day 7. 99mTc-Annexin V-128 SPECT/CT imaging showed significant positive correlation with TUNEL immunohistochemistry and allowed ischemic-induced apoptosis to be detected from day 2 to day 7, peaking on day 3 after middle cerebral artery occlusion. Conclusions Using SPECT/CT imaging, we showed that after transient middle cerebral artery occlusion in rat there was a sustained decrease in cerebral blood flow followed by blood–brain barrier disruption preceding meanwhile apoptosis. Rodent SPECT/CT imaging of cerebral blood flow, blood–brain barrier disruption and apoptosis appears to be an efficient tool for evaluating neuroprotective drugs and regenerative therapies against cerebral ischemia and time-windows for therapeutic intervention.
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Affiliation(s)
- Philippe Garrigue
- INSERM, INSERM UMR_S1076 VRCM Aix-Marseille Université, France
- APHM, Hôpital La Timone, Service de Radiopharmacie, Marseille, France
- CERIMED, Aix-Marseille Université, Marseille, France
| | - Laura Giacomino
- Département Anesthésie-Réanimation adulte, APHM, Aix-Marseille Université, Marseille, France
| | - Chiara Bucci
- Advanced Accelerator Applications, Colleretto Giacosa (TO), Italy
| | - Valeria Muzio
- Advanced Accelerator Applications, Colleretto Giacosa (TO), Italy
| | | | - Florence Sabatier
- INSERM, INSERM UMR_S1076 VRCM Aix-Marseille Université, France
- APHM, Laboratoire de Culture et Thérapie Cellulaire, INSERM, Hôpital La Conception, Marseille, France
| | - Françoise Dignat-George
- INSERM, INSERM UMR_S1076 VRCM Aix-Marseille Université, France
- APHM, Hôpital La Conception, Service d’Hématologie, Marseille, France
| | - Pascale Pisano
- INSERM, INSERM UMR_S1076 VRCM Aix-Marseille Université, France
- APHM, Pôle Pharmacie, Marseille, France
| | - Benjamin Guillet
- INSERM, INSERM UMR_S1076 VRCM Aix-Marseille Université, France
- APHM, Hôpital La Timone, Service de Radiopharmacie, Marseille, France
- CERIMED, Aix-Marseille Université, Marseille, France
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Wang W, Li M, Wang Y, Li Q, Deng G, Wan J, Yang Q, Chen Q, Wang J. GSK-3β inhibitor TWS119 attenuates rtPA-induced hemorrhagic transformation and activates the Wnt/β-catenin signaling pathway after acute ischemic stroke in rats. Mol Neurobiol 2015; 53:7028-7036. [PMID: 26671619 DOI: 10.1007/s12035-015-9607-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Abstract
Hemorrhagic transformation (HT) is a devastating complication for patients with acute ischemic stroke who are treated with tissue plasminogen activator (tPA). It is associated with high morbidity and mortality, but no effective treatments are currently available to reduce HT risk. Therefore, methods to prevent HT are urgently needed. In this study, we used TWS119, an inhibitor of glycogen synthase kinase 3β (GSK-3β), to evaluate the role of the Wnt/β-catenin signaling pathway in recombinant tPA (rtPA)-induced HT. Sprague-Dawley rats were subjected to a middle cerebral artery occlusion (MCAO) model of ischemic stroke and then were administered rtPA, rtPA combined with TWS119, or vehicle at 4 h. The animals were sacrificed 24 h after infarct induction. Rats treated with rtPA showed evident HT, had more severe neurologic deficit, brain edema, and blood-brain barrier breakdown, and had larger infarction volume than did the vehicle group. Rats treated with TWS119 had significantly improved outcomes compared with those of rats treated with rtPA alone. In addition, Western blot analysis showed that TWS119 increased the protein expression of β-catenin, claudin-3, and ZO-1 while suppressing the expression of GSK-3β. These results suggest that TWS119 reduces rtPA-induced HT and attenuates blood-brain barrier disruption, possibly through activation of the Wnt/β-catenin signaling pathway. This study provides a potential therapeutic strategy to prevent tPA-induced HT after acute ischemic stroke.
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Affiliation(s)
- Wei Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Mingchang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuefei Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qian Li
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross Bldg 370B, Baltimore, MD, 21205, USA
| | - Gang Deng
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jieru Wan
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross Bldg 370B, Baltimore, MD, 21205, USA
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400044, China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Jian Wang
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross Bldg 370B, Baltimore, MD, 21205, USA.
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Telischak NA, Wintermark M. Imaging predictors of procedural and clinical outcome in endovascular acute stroke therapy. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40809-015-0004-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lin Y, Xu M, Wan J, Wen S, Sun J, Zhao H, Lou M. Docosahexaenoic acid attenuates hyperglycemia-enhanced hemorrhagic transformation after transient focal cerebral ischemia in rats. Neuroscience 2015; 301:471-9. [PMID: 26102005 DOI: 10.1016/j.neuroscience.2015.06.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/13/2015] [Accepted: 06/15/2015] [Indexed: 11/19/2022]
Abstract
Hemorrhagic transformation (HT) is a feared complication of cerebral ischemic infarction, especially following the use of thrombolytic therapy. In this study, we examined whether docosahexaenoic acid (DHA; 22:6n-3), an omega-3 essential fatty acid family member, can protect the brain from injury and whether DHA can decrease the risk of HT enhanced by hyperglycemia after focal ischemic injury. Male Sprague-Dawley rats were injected with 50% dextrose (6ml/kg intraperitoneally) to induce hyperglycemia 10min before 1.5h of filament middle cerebral artery occlusion (MCAO) was performed. Treatment with DHA (10mg/kg) 5min before reperfusion reduced HT and further improved the 7-day neurological outcome. It also reduced infarct volume, which is consistent with the restricted DWI and T2WI hyperintensive area. Reduced Evans Blue extravasation and increased expression of collagen IV indicated the improved integrity of the blood-brain barrier (BBB) in DHA-treated rats. Moreover, DHA reduced the expression of the intercellular adhesion molecule-1 (ICAM-1) in the ischemic injured brain. Therefore, we conclude that DHA attenuated hyperglycemia-enhanced HT and improved neurological function by preserving the integrity of BBB and reducing inflammation.
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Affiliation(s)
- Y Lin
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China
| | - M Xu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China
| | - J Wan
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China
| | - S Wen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China
| | - J Sun
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China
| | - H Zhao
- Department of Neurosurgery, Stanford University School of Medicine, MSLS Building, P306, 1201 Welch Road, Room P306, Stanford, CA 94305-5327, USA
| | - M Lou
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China.
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Giraud M, Cho TH, Nighoghossian N, Maucort-Boulch D, Deiana G, Østergaard L, Baron JC, Fiehler J, Pedraza S, Derex L, Berthezène Y. Early Blood Brain Barrier Changes in Acute Ischemic Stroke: A Sequential MRI Study. J Neuroimaging 2015; 25:959-63. [PMID: 25702824 DOI: 10.1111/jon.12225] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/18/2014] [Accepted: 01/10/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE We sought to identify MRI factors associated with BBB changes at the acute stage of ischemic stroke. METHODS We analyzed BBB changes on admission and within 3 hours after the first scan. BBB changes was defined as the presence of leptomeningeal and parenchymal contrast enhancement on T1-weighted imaging. Tmax , CBV, and DWI lesion volume were assessed on baseline MRI. Clinical and MRI factors associated with BBB changes were assessed by univariate and multivariate logistic regressions analyses. RESULTS Forty-four patients were included. BBB changes on baseline MRI was observed in 2 of 44 patients (3%). BBB disruption on H3-MRI was present in 19 of 44 patients (43%). Hemodynamic status and baseline ischemic core size were not different between patients with or without BBB changes. BBB alteration on H3 MRI was strongly associated with FLAIR MRI sequence positivity, 16/19 patients (83%) P = .001. CONCLUSION BBB changes are exceptional during the first 3 hours after stroke onset. Delayed BBB alteration was associated with FLAIR positivity mainly reflecting vasogenic edema.
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Affiliation(s)
- Marc Giraud
- Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Delphine Maucort-Boulch
- Department of Biostatistics, Hospices Civils de Lyon, Lyon, France, CNRS UMR 5558, Equipe Biostatistique Santé, Pierre-Bénite, France, Université Lyon I, Villeurbanne, France
| | - Gianluca Deiana
- Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Leif Østergaard
- Department of Neuroradiology, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark
| | - Jean-Claude Baron
- Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK, Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France
| | - Jens Fiehler
- Departments of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Laurent Derex
- Department of Stroke Medicine, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
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Veksler R, Shelef I, Friedman A. Blood-brain barrier imaging in human neuropathologies. Arch Med Res 2014; 45:646-52. [PMID: 25453223 DOI: 10.1016/j.arcmed.2014.11.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/20/2014] [Indexed: 01/22/2023]
Abstract
The blood-brain barrier (BBB) is essential for normal function of the brain, and its role in many brain pathologies has been the focus of numerous studies during the last decades. Dysfunction of the BBB is not only being shown in numerous brain diseases, but animal studies have indicated that it plays a direct key role in the genesis of neurovascular dysfunction and associated neurodegeneration. As such evidence accumulates, the need for robust and clinically applicable methods for minimally invasive assessment of BBB integrity is becoming urgent. This review provides an introduction to BBB imaging methods in the clinical scenario. First, imaging modalities are reviewed, with a focus on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). We then proceed to review image analysis methods, including quantitative and semi-quantitative methods. The advantages and limitations of each approach are discussed, and future directions and questions are highlighted.
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Affiliation(s)
- Ronel Veksler
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Shelef
- Department of Medical Imaging, Soroka University Medical Center and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Friedman
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Canada.
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