Slow Blood-Brain Barrier Leakage Is Associated with Acute Brain Ischemia and Portends Increased Risk for Delayed Stroke (S47.007)

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. 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. 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 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. Disclosure: Dr. Serlin has nothing to disclose. Dr. Ofer has nothing to disclose. Dr. Ben-Arie has nothing to disclose. Dr. Veksler has nothing to disclose. Dr. Ifergane has nothing to disclose. Dr. Shelef has nothing to disclose. Dr. Minuk has nothing to disclose. Dr. Horev has nothing to disclose. Dr. Friedman has nothing to disclose.