Blood-brain barrier disruption is associated with increased mortality after endovascular therapy.
OBJECTIVE
To evaluate the incidence, baseline characteristics, and clinical prognosis of blood-brain barrier (BBB) disruption after endovascular therapy in acute ischemic stroke patients.


METHODS
A total of 220 patients treated with endovascular therapy between April 2007 and October 2011 were identified from a prospective, clinical, thrombolysis registry. All patients underwent a nonenhanced CT scan immediately after treatment. CT scan or MRI was systematically realized at 24 hours to assess intracranial hemorrhage complications. BBB disruption was defined as a hyperdense lesion on the posttreatment CT scan.


RESULTS
BBB disruption was found in 128 patients (58.2%; 95% confidence interval [CI], 51.4%-64.9%). Cardioembolic etiology, high admission NIH Stroke Scale score, high blood glucose level, internal carotid artery occlusion, and use of combined endovascular therapy (chemical and mechanical revascularization) were independently associated with BBB disruption. Patients with BBB disruption had lower rates of early major neurologic improvement (8.6% vs 31.5%, p < 0.001), favorable outcome (39.8% vs 61.8%, p = 0.002), and higher rates of 90-day mortality (34.4% vs 14.6%, p = 0.001) and hemorrhagic complications (42.2% vs 8.7%, p < 0.001) than those without BBB disruption. By multivariable analysis, patients with BBB disruption remained with a lower rate of early neurologic improvement (adjusted odds ratio [OR], 0.28; 95% CI, 0.11-0.70) and with a higher rate of mortality (adjusted OR, 2.37; 95% CI, 1.06-5.32) and hemorrhagic complications (adjusted OR, 6.38; 95% CI, 2.66-15.28).


CONCLUSIONS
BBB disruption has a detrimental effect on outcome and is independently associated with mortality after endovascular therapy. BBB disruption assessment may have a role in prognosis staging in these patients.
Department of Neurology and Stroke Centre, Bichat University Hospital.
Jean-Philippe
JP
Desilles
Aymeric
A
Rouchaud
Julien
J
Labreuche
Elena
E
Meseguer
Jean-Pierre
JP
Laissy
Jean-Michel
JM
Serfaty
Bertrand
B
Lapergue
Isabelle F
IF
Klein
Céline
C
Guidoux
Lucie
L
Cabrejo
Gaia
G
Sirimarco
Philippa C
PC
Lavallée
Elisabeth
E
Schouman-Claeys
Pierre
P
Amarenco
Mikael
M
Mazighi
D000368:Aged; D001812:Blood-Brain Barrier / Q000473:pathology / Q000503:physiopathology*; D002545:Brain Ischemia / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000401:mortality; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator