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Updated: Sep 27, 2025
Measuring Post-Stroke Cerebral Edema, Infarct Zone and Blood-Brain Barrier Breakdown in a Single Set of Rodent Brain Samples
Published on: October 23, 2020
Internal border zone injury predicts the functional outcome of acute MCA stroke patients
1Radiology Department, CHU de Saint Etienne, Avenue Albert Raimond, 42270 Saint-Priest-En-Jarez, France.
Background And Purpose:
Classification of deep (D), superficial (S) MCA territories and their junctional vascular area (the internal border zone, IBZ) can help to identify patients most likely to benefit from aggressive reperfusion therapy after stroke. We tested the prognostic value of an IBZ injury compared to DWI-ASPECTS and infarct volume.
Materials And Methods:
DW lesions of 168 patients with acute (4.2±6.5 h) MCA strokes were retrospectively examined and manually delineated. Patients with haemorrhagic transformation or other neurological diseases were excluded. Clinical data were recorded within 24 h following symptom onset and 48 h for patients who benefited from reperfusion therapy. The occurrence of an IBZ injury was determined using a standardized stereotaxic atlas. Performance to predict a good outcome (mRS<3 at 3 months) was estimated through ROC curves for DWI-ASPECTS≤6, lesion volume≥100 mL and IBZ injury. Logistic regression models were performed to estimate independent outcomes for infarct volume and IBZ injury.
Results:
Infarcts involving the IBZ were larger (94.9±98.8 mL vs. 30.2±31.3 mL), had higher NIHSS (13.8±7.2 vs. 7.2±5.7), more frequent MCA occlusions (64.9% vs. 28.3%), and worse outcomes (mRS 3.0±1.8 vs. 1.9±1.7), and were less responsive to IVtPA (34±47% vs. 55±48% of NIHSS improvement). The area under the ROC curves was comparable between the occurrence of IBZ injury (0.651), ASPECTS≤6 (0.657) and volume≥100 mL (0.629). Logistic regression analyses showed an independent effect of an IBZ injury, especially for superficial MCA strokes and for patients who benefited from reperfusion therapy.
Conclusion:
An IBZ injury is an early and independent marker of stroke severity, functional prognosis and treatment responsiveness.
Insights
Internal border zone (IBZ) injury is a significant early indicator of stroke severity and prognosis. Identifying IBZ injury helps predict which stroke patients will best respond to reperfusion therapy.
Area of Science:
- Neurology
- Neuroimaging
- Stroke Medicine
Background:
- The internal border zone (IBZ) is a critical vascular territory in the middle cerebral artery (MCA) where infarcts can significantly impact stroke outcomes.
- Accurate classification of MCA territories, including the IBZ, is crucial for identifying stroke patients who may benefit from aggressive reperfusion therapies.
Purpose of the Study:
- To evaluate the prognostic value of internal border zone (IBZ) injury in acute middle cerebral artery (MCA) strokes.
- To compare the predictive performance of IBZ injury against established markers like DWI-ASPECTS and infarct volume for stroke outcomes.
Main Methods:
- Retrospective analysis of diffusion-weighted (DW) lesions in 168 acute MCA stroke patients.
- Manual delineation of lesions and determination of IBZ injury using a standardized stereotaxic atlas.
- Performance estimation using Receiver Operating Characteristic (ROC) curves and logistic regression to predict good functional outcome (mRS<3 at 3 months).
Main Results:
- Infarcts involving the IBZ were significantly larger, associated with higher NIHSS scores, more frequent MCA occlusions, and worse functional outcomes.
- IBZ injury demonstrated comparable predictive performance to DWI-ASPECTS and infarct volume in ROC analyses.
- Logistic regression confirmed IBZ injury as an independent predictor of stroke severity and prognosis, particularly in superficial MCA strokes and in patients receiving reperfusion therapy.
Conclusions:
- Internal border zone (IBZ) injury serves as an early and independent marker for stroke severity.
- IBZ injury is a valuable prognostic indicator for functional recovery after stroke.
- The presence of IBZ injury predicts treatment responsiveness to reperfusion therapies.
