Abstract Details

Title Slow Blood-Brain Barrier Leakage Is Associated with Acute Brain Ischemia and Portends Increased Risk for Delayed Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S47 - Stroke Outcomes and Recurrence (2:06 PM-2:17 PM)

Poster/Presentation
Number 007

Background The diagnosis of transient ischemic attack (TIA) is challenging. Evidence of acute ischemia on diffusion-weighted imaging (DWI) is highly variable and confirmed in only about one-third of patients. BBBD is a prominent feature in cerebral ischemia and a key mechanism underlying delayed neurological complications. Yet, to date, no clinical studies have characterized BBBD in TIA.

Objective

To assess blood-brain barrier dysfunction (BBBD) mapping in patients with transient neurological deficit, as a diagnostic and predictive biomarker required for risk stratification and stroke prevention.

Design/Methods Observational, single-center prospective cohort study conducted in a tertiary stroke referral center from October 2012 through December 2016. We used dynamic contrast-enhanced MRI for quantification of fast and slow BBBD in 57 patients with TIA/minor stroke and 50 healthy controls. Patients were followed until October 31, 2017.

Results Mean age of patients (64.9% men) was 58.4 years. Thirty-one (54.4%) had negative and 26 (45.6%) had positive DWI. The extent of BBBD was significantly higher in patients compared to controls (65.3% men; mean age, 40.7 years; fast BBBD, P<.001; slow BBBD, P=.002) and to age-matched controls (n=23, 55.8 years; fast, P<.001, slow, P=.05). Slow but not fast BBBD was significantly more prevalent in patients with positive DWI (P=.05). Slow BBBD corresponded with the clinical presentation in 41 patients (72%). Patients who later developed new stroke (n=7) did not differ by their initial DWI but had higher degree of slow BBBD (P=.03). Patients with extensive BBBD (≥ interquartile range above the median of pathological voxels) had a risk ratio of 5.35 (95% CI=1.50-19.09) for delayed stroke, compared to 0.89 (95% CI=0.22-3.63) for patients with positive DWI.

Conclusions We propose a quantitative approach for detection of microvascular pathology and subtle brain ischemia. Slow BBBD is a potential biomarker for the development of delayed stroke.

Authors/Disclosures
Yonatan Serlin, MD (McGill University) PRESENTER	Dr. Serlin has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Gal Ifergane, MD (Soroka University Medical Center)	Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medison pharma. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Teva. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceretrieve. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medison pharma. Dr. Ifergane has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Ifergane has received research support from Teva.
	No disclosure on file
Jeffrey Minuk, MD (Jewish General Hospital SMBD)	No disclosure on file
	No disclosure on file
	No disclosure on file

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