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The Blood-brain Barrier00:49

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Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this...
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Hemorrhagic Stroke ll: Pathophysiology01:29

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A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
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Ischemic Stroke ll: Pathophysiology01:15

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An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
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Related Experiment Video

Updated: May 7, 2026

Rat Model of Blood-brain Barrier Disruption to Allow Targeted Neurovascular Therapeutics
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Core Blood-Brain Barrier Disruption in Patients With Large Vessel Occlusion.

Richard Leigh1, Nefeli Valyraki2,3, Nae-Yuh Wang4

  • 1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.L.).

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Core blood-brain barrier disruption in acute ischemic stroke is linked to poor outcomes. This imaging marker may help guide treatment decisions for patients with large vessel occlusion.

Keywords:
angiographyblood-brain barrierendovascular proceduresischemic strokemagnetic resonance imaging

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Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Medicine

Background:

  • Multimodal imaging advances stroke treatment for large vessel occlusion.
  • Blood-brain barrier (BBB) disruption in the ischemic core correlates with hemorrhagic transformation.
  • Associations between core BBB disruption (cBBBD) and clinical/imaging variables, and outcomes, remain unexplored.

Purpose of the Study:

  • To explore associations between core BBB disruption (cBBBD) and baseline clinical/imaging variables.
  • To investigate the relationship between cBBBD and 3-month functional outcomes in acute ischemic stroke patients.
  • To evaluate cBBBD as a potential imaging biomarker for guiding stroke treatment.

Main Methods:

  • Retrospective multicenter analysis of anterior circulation acute ischemic stroke patients with large vessel occlusion.
  • Utilized magnetic resonance imaging (MRI) with perfusion-weighted imaging to quantify contrast leakage and calculate cBBBD.
  • Employed linear and logistic regression analyses, controlling for relevant covariates, to assess associations with clinical and imaging variables and 3-month outcomes.

Main Results:

  • Out of 291 analyzed patients, admission NIH Stroke Scale and glucose levels were independently correlated with cBBBD.
  • All imaging variables showed strong correlations with cBBBD, with the mismatch ratio exhibiting the strongest association (r²=0.254).
  • Increasing cBBBD was independently associated with poor functional outcome (aOR 1.16 per 1% increase), indicating a 16% increased odds of poor outcome.

Conclusions:

  • Core BBB disruption in acute ischemic stroke with large vessel occlusion is independently associated with clinical outcomes.
  • cBBBD emerges as a novel imaging profile in acute stroke.
  • This imaging marker may assist in optimizing treatment strategies for stroke patients.