Post-stroke blood-brain barrier disruption and poor functional outcome in patients receiving thrombolytic therapy

Zurab Nadareishvili, Alexis N. Simpkins, Emi Hitomi, Dennys Reyes, Richard Leigh

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background and Purpose: The role played by post-stroke inflammation after an ischemic event in limiting functional recovery remains unclear. One component of post-stroke inflammation is disruption of the blood-brain barrier (BBB). This study examines the relationship between post-stroke BBB disruption and functional outcome. Methods: Acute stroke patients treated with thrombolysis underwent magnetic resonance imaging scanning 24 h and 5 days after their initial event. BBB permeability maps were generated from perfusion weighted imaging. Average permeability was calculated in the affected hemisphere. Good functional outcome, defined as a modified Rankin score of 0 or 1, was compared with average permeability using logistic regression. Results: Of the 131 patients enrolled, 76 patients had the necessary data to perform the analysis at 24 h, and 58 -patients had data for the 5-day assessment. Higher BBB permeability measured at 24 h (OR 0.57; 95% CI 0.33-0.99, p = 0.045) and at 5 days (OR 0.24; 95% CI 0.09-0.66, p = 0.005) was associated with worse functional outcome 1-3 months after the acute ischemic stroke. For every percentage increase in BBB disruption at 5 days, there was a 76% decrease in the chance of achieving a good functional outcome after stroke. Multivariate analysis found this to be independent of age, stroke volume, or clinical stroke severity. Conclusions: Post-stroke BBB disruption appears to be predictive of functional outcome irrespective of stroke size.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalCerebrovascular Diseases
Issue number3-4
StatePublished - Jul 1 2019


  • Blood-brain barrier
  • Functional outcome
  • Ischemic stroke
  • Magnetic resonance imaging
  • Post-stroke inflammation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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