National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, MD, 20892, USA.
BMC Neurol. 2020 Feb 13;20(1):54. doi: 10.1186/s12883-020-01634-2.
Current guidelines limit thrombolytic treatment of stroke to those patients who present within 4.5 h to minimize the risk of hemorrhagic complications. Risk of hemorrhage increases with increasing blood-brain barrier (BBB) disruption. This study aimed to determine, in a cohort of patients presenting outside of an IV-tPA treatment window, whether disruption of the BBB is time dependent, and what proportion of patients could be safely treated.
We analyzed untreated stroke patients, seen between 2011 and 2015, who had MRI studies in the time window of 4 to 24 h from symptoms onset. Permeability of the BBB was measured within the ischemic tissue using an application of dynamic susceptibility contrast imaging. Patients were dichotomized into two groups based on a 20% threshold of BBB disruption and compared using logistic regression.
Of the 222 patients included in the final analysis, over half, 129 (58%), had preserved BBB integrity below the 20% threshold. There was no relationship between time imaged after symptom onset and the amount of BBB disruption (p = 0.138) across the population; BBB disruption varied widely.
Estimating BBB integrity may help to expand the treatment window for stroke patients by identifying those individuals for whom thrombolytic therapy can be considered.
目前的指南将溶栓治疗中风的时间限制在发病后 4.5 小时内，以最大程度地降低出血并发症的风险。出血风险随着血脑屏障（BBB）破坏的增加而增加。本研究旨在确定在超出 IV-tPA 治疗窗口的患者队列中，BBB 的破坏是否具有时间依赖性，以及有多少患者可以安全治疗。
我们分析了在症状发作后 4 至 24 小时的 MRI 研究时间窗内就诊的未经治疗的中风患者。使用动态对比敏感性成像来测量缺血组织内 BBB 的通透性。根据 BBB 破坏程度达到 20%的阈值将患者分为两组，并使用逻辑回归进行比较。
在最终分析的 222 名患者中，超过一半，129 名（58%）患者的 BBB 完整性保持在 20%阈值以下。在整个患者群体中，成像时间与 BBB 破坏的程度之间没有关系（p=0.138）；BBB 的破坏程度差异很大。
估计 BBB 的完整性可能有助于通过识别那些可以考虑溶栓治疗的个体来扩大中风患者的治疗窗口。
