title: Relevance of blood-brain barrier disruption after endovascular treatment of ischemic stroke: dual-energy computed tomographic study.
abstract: OBJECTIVE
  Computed tomographic (CT) high attenuation (HA) areas after endovascular therapy for acute ischemic stroke are a common finding indicative of blood-brain barrier disruption. Dual-energy CT allows an accurate differentiation between HA areas related to contrast staining (CS) or to brain hemorrhage (BH). We sought to evaluate the prognostic significance of the presence of CS and BH after endovascular therapy.
  
  
  METHODS
  A prospective cohort of 132 patients treated with endovascular therapy was analyzed. According to dual-energy CT findings, patients were classified into 3 groups: no HA areas (n=53), CS (n=32), and BH (n=47). The rate of new hemorrhagic transformations was recorded at follow-up neuroimaging. Clinical outcome was evaluated at 90 days with the modified Rankin Scale (poor outcome, 3-6).
  
  
  RESULTS
  Poor outcome was associated with the presence of CS (odds ratio [OR], 11.3; 95% confidence interval, 3.34-38.95) and BH (OR, 10.4; 95% confidence interval, 3.42-31.68). The rate of poor outcome despite complete recanalization was also significantly higher in CS (OR, 9.7; 95% confidence interval, 2.55-37.18) and BH (OR, 15.1; 95% confidence interval, 3.85-59.35) groups, compared with the no-HA group. Patients with CS disclosed a higher incidence of delayed hemorrhagic transformation at follow-up (OR, 4.5; 95% confidence interval, 1.22-16.37) compared with no-HA patients.
  
  
  CONCLUSIONS
  Blood-brain barrier disruption, defined as CS and BH on dual-energy CT, was associated with poor clinical outcomes in patients with stroke treated with endovascular therapies. Moreover, isolated CS was associated with delayed hemorrhagic transformation. These results support the clinical relevance of blood-brain barrier disruption in acute stroke.
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
authors: Arturo
authors: A
authors: Renú
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
authors: Sergio
authors: S
authors: Amaro
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
authors: Carlos
authors: C
authors: Laredo
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
authors: Luis San
authors: LS
authors: Román
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
authors: Laura
authors: L
authors: Llull
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
authors: Antonio
authors: A
authors: Lopez
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
authors: Xabier
authors: X
authors: Urra
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
authors: Jordi
authors: J
authors: Blasco
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
authors: Laura
authors: L
authors: Oleaga
authors: From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.). achamorro@clinic.ub.es.
authors: Ángel
authors: Á
authors: Chamorro
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000792:Angiography; D001812:Blood-Brain Barrier; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000517:prevention & control; D003287:Contrast Media / Q000737:chemistry; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives / Q000494:pharmacology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D005343:Fibrinolytic Agents; D007472:Iohexol; C038192:iopromide
keywords: blood–brain barrier; stroke; thrombolytic therapy