{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T07:50:31Z","timestamp":1793260231421,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>In patients with acute ischemic stroke treated with reperfusion therapy we aimed to evaluate whether pretreatment blood\u2013brain barrier (BBB) leakage is associated with subsequent hemorrhagic transformation (HT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively screened patients with acute ischemic stroke treated with intravenous thrombolysis and\/or endovascular treatment. Before treatment, each patient received computed tomography (CT), CT angiography, and CT perfusion. We assessed pretreatment BBB leakage within the ischemic area using the volume transfer constant (K<jats:sup>trans<\/jats:sup>) value. Our primary outcome was relevant HT, defined as hemorrhagic infarction type 2 or parenchymal hemorrhage type 1 or 2. We evaluated independent associations between BBB leakage and HT using logistic regression, adjusting for age, sex, baseline stroke severity, Alberta Stroke Program Early CT Score (ASPECTS)\u00a0\u2265\u00a06, treatment type, and onset\u2010to\u2010treatment time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled 171 patients with available assessment of BBB leakage. The patients' mean (\u00b1SD) age was 75.5 (\u00b111.8) years, 86 (50%) were men, and the median (interquartile range) National Institutes of Health Stroke Scale score was 18 (12\u201323). A total of 32 patients (18%) received intravenous thrombolysis, 102 (60%) underwent direct endovascular treatment, and 37 (22%) underwent both. Patients with relevant HT (<jats:italic>N<\/jats:italic>\u00a0=\u00a031;18%) had greater mean BBB leakage (K<jats:sup>trans<\/jats:sup> 0.77 vs. 0.60; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.027). After adjustment in the logistic regression model, we found that BBB leakage was associated both with a more than twofold risk of relevant HT (odds ratio [OR]\u00a02.50; 95% confidence interval [CI]\u00a01.03\u20136.03 per K<jats:sup>trans<\/jats:sup> point increase; OR\u00a02.34; 95% CI\u00a01.06\u20135.17 for K<jats:sup>trans<\/jats:sup> values\u00a0&gt;\u00a00.63 [mean BBB leakage value]) and with symptomatic intracerebral hemorrhage (OR\u00a04.30; 95% CI\u00a01.13\u201313.77 per K<jats:sup>trans<\/jats:sup> point increase).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pretreatment BBB leakage before reperfusion therapy was associated with HT, and may help to identify patients at risk of HT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.14985","type":"journal-article","created":{"date-parts":[[2021,6,18]],"date-time":"2021-06-18T14:59:25Z","timestamp":1624028365000},"page":"3147-3154","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":78,"title":["Blood\u2013brain barrier leakage and hemorrhagic transformation: The Reperfusion Injury in Ischemic StroKe (RISK) study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3941-7383","authenticated-orcid":false,"given":"Francesco","family":"Arba","sequence":"first","affiliation":[{"name":"Stroke Unit Careggi University Hospital Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Piccardi","sequence":"additional","affiliation":[{"name":"Stroke Unit Careggi University Hospital Florence 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