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DC Field | Value | Language |
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dc.contributor.author | Ng, Felix C. | - |
dc.contributor.author | Churilov, Leonid | - |
dc.contributor.author | Yassi, Nawaf | - |
dc.contributor.author | Kleinig, Timothy J. | - |
dc.contributor.author | Thijs, Vincent | - |
dc.contributor.author | Wu, Teddy Y. | - |
dc.contributor.author | Shah, Darshan G.. | - |
dc.contributor.author | Dewey, Helen M. | - |
dc.contributor.author | Sharma, Gagan | - |
dc.contributor.author | Desmond, Patricia M. | - |
dc.contributor.author | Yan, Bernard | - |
dc.contributor.author | Parsons, Mark W. | - |
dc.contributor.author | Donnan, Geoffrey A. | - |
dc.contributor.author | Davis, Stephen M. | - |
dc.contributor.author | Mitchell, Peter J. | - |
dc.contributor.author | Leigh, Richard | - |
dc.contributor.author | Campbell, Bruce C. V. | - |
dc.contributor.author | Part, EXTEND-IA TNK | - |
dc.contributor.author | Investigators | - |
dc.date.accessioned | 2023-04-24T02:44:21Z | - |
dc.date.available | 2023-04-24T02:44:21Z | - |
dc.date.issued | 2022-05 | - |
dc.identifier.uri | https://repository.southwesthealthcare.com.au/swhealthcarejspui/handle/1/3849 | - |
dc.description.abstract | BACKGROUND: Factors contributing to cerebral edema in the post-hyperacute period of ischemic stroke (first 24-72 hours) are poorly understood. Blood-brain barrier (BBB) disruption and postischemic hyperperfusion reflect microvascular dysfunction and are associated with hemorrhagic transformation. We investigated the relationships between BBB integrity, cerebral blood flow, and space-occupying cerebral edema in patients who received acute reperfusion therapy. METHODS: We performed a pooled analysis of patients treated for anterior circulation large vessel occlusion in the EXTEND-IA TNK and EXTEND-IA TNK part 2 trials who had MRI with dynamic susceptibility contrast-enhanced perfusion-weighted imaging 24 hours after treatment. We investigated the associations between BBB disruption and cerebral blood flow within the infarct with cerebral edema assessed using 2 metrics: first midline shift (MLS) trichotomized as an ordinal scale of negligible (<1 mm), mild (>/=1 to <5 mm), or severe (>/=5 mm), and second relative hemispheric volume (rHV), defined as the ratio of the 3-dimensional volume of the ischemic hemisphere relative to the contralateral hemisphere. RESULTS: Of 238 patients analyzed, 133 (55.9%) had negligible, 93 (39.1%) mild, and 12 (5.0%) severe MLS at 24 hours. The associated median rHV was 1.01 (IQR, 1.00-1.028), 1.03 (IQR, 1.01-1.077), and 1.15 (IQR, 1.08-1.22), respectively. MLS and rHV were associated with poor functional outcome at 90 days (P<0.002). Increased BBB permeability was independently associated with more edema after adjusting for age, occlusion location, reperfusion, parenchymal hematoma, and thrombolytic agent used (MLS cOR, 1.12 [95% CI, 1.03-1.20], P=0.005; rHV beta, 0.39 [95% CI, 0.24-0.55], P<0.0001), as was reduced cerebral blood flow (MLS cOR, 0.25 [95% CI, 0.10-0.58], P=0.001; rHV beta, -2.95 [95% CI, -4.61 to -11.29], P=0.0006). In subgroup analysis of patients with successful reperfusion (extended Treatment in Cerebral Ischemia 2b-3, n=200), reduced cerebral blood flow remained significantly associated with edema (MLS cOR, 0.37 [95% CI, 0.14-0.98], P=0.045; rHV beta, -2.59 [95% CI, -4.32 to -0.86], P=0.004). CONCLUSIONS: BBB disruption and persistent hypoperfusion in the infarct after reperfusion treatment is associated with space-occupying cerebral edema. Further studies evaluating microvascular dysfunction during the post-hyperacute period as biomarkers of poststroke edema and potential therapeutic targets are warranted. | - |
dc.relation.isversionof | 20211223 | - |
dc.subject | Blood-Brain Barrier | - |
dc.subject | Brain Edema | - |
dc.subject | Brain Ischemia | - |
dc.subject | Cerebral Infarction | - |
dc.subject | Cerebrovascular Circulation | - |
dc.subject | Humans | - |
dc.subject | Blood-Brain Barrier | - |
dc.subject | Hematoma | - |
dc.subject | Magnetic Resonance Imaging | - |
dc.subject | Perfusion | - |
dc.subject | Permeability | - |
dc.title | Microvascular Dysfunction in Blood-Brain Barrier Disruption and Hypoperfusion Within the Infarct Posttreatment Are Associated With Cerebral Edema | - |
dc.type | Journal Article | - |
dc.identifier.journaltitle | Stroke | - |
dc.accession.number | 34937423 | - |
dc.identifier.url | https://www.ncbi.nlm.nih.gov/pubmed/34937423 | - |
dc.description.affiliation | Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.D., S.M.D., B.C.V.C.). | - |
dc.description.affiliation | The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (F.C.N., V.T.). | - |
dc.description.affiliation | Department of Neurology, Austin Hospital, Austin Health, Heidelberg, Australia (L.C., V.T., B.C.V.C.). | - |
dc.description.affiliation | Melbourne Medical School, The University of Melbourne, Heidelberg, Australia (L.C.). | - |
dc.description.affiliation | Population Health and Immunity Division. The Walter and Eliza Hall Institute of Medical Research. Parkville, Australia (N.Y.). | - |
dc.description.affiliation | Department of Neurology, Royal Adelaide Hospital, Australia (T.J.K.). | - |
dc.description.affiliation | Department of Neurology, Christchurch Hospital, New Zealand (T.Y.W.). | - |
dc.description.affiliation | Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia (D.G.S.). | - |
dc.description.affiliation | Eastern Health and Eastern Health Clinical School, Department of Neurosciences, Monash University, Clayton, Australia (H.M.D.). | - |
dc.description.affiliation | Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.M.D., B.Y., P.J.M.). | - |
dc.description.affiliation | Department of Neurology, John Hopkins University, Baltimore, MD (R.L.). | - |
dc.format.startpage | 1597-1605 | - |
dc.source.volume | 53 | - |
local.issue.number | 5 | - |
dc.identifier.notes | Meta-Analysis | - |
dc.identifier.importdoi | 10.1161/STROKEAHA.121.036104 | - |
dc.identifier.date | May | - |
dc.identifier.date | 2022 | - |
Appears in Collections: | SWH Data Contributions |
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