title: Blood-brain barrier permeability derangements in posterior circulation ischemic stroke: frequency and relation to hemorrhagic transformation.
abstract: BACKGROUND
  Early disruption of the blood-brain barrier (BBB) due to severe ischemia can be detected by MRI T2* permeability imaging. In middle cerebral artery (MCA) infarction, pretreatment T2* permeability derangements have been found in 22% of patients and are powerful predictors of hemorrhagic transformation after revascularization therapy. The frequency, clinical correlates, and relation to hemorrhagic transformation of permeability derangements in posterior circulation have not been previously explored, and may differ as ischemia volume and collateral status are different between vertebrobasilar and MCA infarcts.
  
  
  METHODS
  We analyzed clinical and pretreatment MRI data on consecutive patients undergoing recanalization therapy for acute vertebrobasilar ischemia at a medical center November 2001 through September 2009. Pretreatment MRI permeability images were derived from perfusion source imaging acquisitions. Permeability abnormality was detected as persisting increased signal intensity at later time points in perfusion MRI acquisition, indicating local accumulation of contrast caused by BBB leakage.
  
  
  RESULTS
  Among the 14 patients meeting study entry criteria, mean age was 71.1 years and median pretreatment NIHSS was 20.5. Permeability imaging abnormality was present in 1 of the 14 patients (7%). Among 14 patients, post-treatment parenchymal hematoma occurred in one and more minor degrees of hemorrhagic transformation in four. The one patient with pretreatment permeability abnormality was the patient to develop post-treatment parenchymal hematoma (Fisher's exact test, P=0.07).
  
  
  CONCLUSIONS
  Pretreatment permeability abnormality, an indicator of BBB derangements, is an infrequent finding in acute posterior circulation ischemic stroke and may be associated with an increased risk of parenchymal hematoma development undergoing recanalization therapy.
authors.affiliation: UCLA Stroke Center, Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Jeffry R
authors.initials: JR
authors.lastname: Alger
authors.forename: Qing
authors.initials: Q
authors.lastname: Hao
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Paul M
authors.initials: PM
authors.lastname: Vespa
authors.forename: Michael T
authors.initials: MT
authors.lastname: Froehler
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Tenser
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Villablanca
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.forename: Gary R
authors.initials: GR
authors.lastname: Duckwiler
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tateshima
authors.forename: Nestor
authors.initials: N
authors.lastname: Gonzalez
authors.forename: Fernando
authors.initials: F
authors.lastname: Vinuela
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier / Q000378:metabolism* / Q000473:pathology; D002545:Brain Ischemia / Q000378:metabolism / Q000473:pathology; D002199:Capillary Permeability / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000378:metabolism* / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000378:metabolism* / Q000473:pathology