title: Pretreatment blood-brain barrier damage and post-treatment intracranial hemorrhage in patients receiving intravenous tissue-type plasminogen activator.
abstract: OBJECTIVE
  Early blood-brain barrier damage after acute ischemic stroke has previously been qualitatively linked to subsequent intracranial hemorrhage (ICH). In this quantitative study, it was investigated whether the amount of blood-brain barrier damage evident on pre-tissue-type plasminogen activator MRI scans was related to the degree of post-tissue-type plasminogen activator ICH in patients with acute ischemic stroke.
  
  
  METHODS
  Analysis was performed on a database of patients with acute ischemic stroke provided by the Stroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (VISTA) Imaging Investigators. Patients with perfusion-weighted imaging lesions>10 mL and negative gradient-recalled echo imaging before intravenous tissue-type plasminogen activator were included. Postprocessing of the perfusion-weighted imaging source images was performed to estimate changes in blood-brain barrier permeability within the perfusion deficit relative to the unaffected hemisphere. Follow-up gradient-recalled echo images were reviewed for evidence of ICH and divided into 3 groups according to European Cooperative Acute Stroke Study (ECASS) criteria: no hemorrhage, hemorrhagic infarction, and parenchymal hematoma.
  
  
  RESULTS
  Seventy-five patients from the database met the inclusion criteria, 28 of whom experienced ICH, of which 19 were classified as hemorrhagic infarction and 9 were classified as parenchymal hematoma. The mean permeability (±SDs), expressed as an index of contrast leakage, was 17.0±8.8% in the no hemorrhage group, 19.4±4.0% in the hemorrhagic infarction group, and 24.6±4.5% in the parenchymal hematoma group. Permeability was significantly correlated with ICH grade in univariate (P=0.007) and multivariate (P=0.008) linear regression modeling.
  
  
  CONCLUSIONS
  A perfusion-weighted imaging-derived index of blood-brain barrier damage measured before intravenous tissue-type plasminogen activator is given is associated with the severity of ICH after treatment in patients with acute ischemic stroke.
authors.affiliation: From the Departments of Neurology and Radiology (R.L.), Neurology, Physical Medicine and Rehabilitation and Cognitive Science (A.E.H.), Neurology and Neuroscience (J.W.K.), and Radiology (P.B.B.), Johns Hopkins University, Baltimore, MD; and Department of Radiology, Emory University, Atlanta, GA (S.S.J.). rleigh4@jhu.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Leigh
authors.affiliation: From the Departments of Neurology and Radiology (R.L.), Neurology, Physical Medicine and Rehabilitation and Cognitive Science (A.E.H.), Neurology and Neuroscience (J.W.K.), and Radiology (P.B.B.), Johns Hopkins University, Baltimore, MD; and Department of Radiology, Emory University, Atlanta, GA (S.S.J.).
authors.forename: Shyian S
authors.initials: SS
authors.lastname: Jen
authors.affiliation: From the Departments of Neurology and Radiology (R.L.), Neurology, Physical Medicine and Rehabilitation and Cognitive Science (A.E.H.), Neurology and Neuroscience (J.W.K.), and Radiology (P.B.B.), Johns Hopkins University, Baltimore, MD; and Department of Radiology, Emory University, Atlanta, GA (S.S.J.).
authors.forename: Argye E
authors.initials: AE
authors.lastname: Hillis
authors.affiliation: From the Departments of Neurology and Radiology (R.L.), Neurology, Physical Medicine and Rehabilitation and Cognitive Science (A.E.H.), Neurology and Neuroscience (J.W.K.), and Radiology (P.B.B.), Johns Hopkins University, Baltimore, MD; and Department of Radiology, Emory University, Atlanta, GA (S.S.J.).
authors.forename: John W
authors.initials: JW
authors.lastname: Krakauer
authors.affiliation: From the Departments of Neurology and Radiology (R.L.), Neurology, Physical Medicine and Rehabilitation and Cognitive Science (A.E.H.), Neurology and Neuroscience (J.W.K.), and Radiology (P.B.B.), Johns Hopkins University, Baltimore, MD; and Department of Radiology, Emory University, Atlanta, GA (S.S.J.).
authors.forename: Peter B
authors.initials: PB
authors.lastname: Barker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier / Q000473:pathology / Q000503:physiopathology*; D002545:Brain Ischemia / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D002199:Capillary Permeability / Q000187:drug effects / Q000502:physiology*; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016208:Databases, Factual; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: blood–brain barrier; magnetic resonance imaging; stroke