Pretreatment blood-brain barrier disruption and post-endovascular intracranial hemorrhage.
OBJECTIVE
This study sought to confirm the relationship between the degree of blood-brain barrier (BBB) damage and the severity of intracranial hemorrhage (ICH) in a population of patients who received endovascular therapy.


METHODS
The degree of BBB disruption on pretreatment MRI scans was analyzed, blinded to follow-up data, in the DEFUSE 2 cohort in which patients had endovascular therapy within 12 hours of stroke onset. BBB disruption was compared with ICH grade previously established by the DEFUSE 2 core lab. A prespecified threshold for predicting parenchymal hematoma (PH) was tested.


RESULTS
Of the 108 patients in the DEFUSE 2 trial, 100 had adequate imaging and outcome data and were included in this study; 24 developed PH. Increasing amounts of BBB disruption on pretreatment MRIs was associated with increasing severity of ICH grade (p = 0.004). BBB disruption on the pretreatment scan was associated with PH (p = 0.020) with an odds ratio for developing PH of 1.69 for each 10% increase in BBB disruption (95% confidence interval 1.09-2.64), although a reliably predictive threshold was not identified.


CONCLUSIONS
The amount of BBB disruption on pretreatment MRI is associated with the severity of ICH after acute intervention. This relationship has now been identified in patients receiving IV, endovascular, and combined therapies. Further study is needed to determine its role in guiding treatment.
From the Neuro Vascular Brain Imaging Unit (R.L.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Stanford Stroke Center (S.C., G.W.A., M.G.L.), Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA; Department of Medicine and Neurology (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Australia; and Department of Radiology (M.P.M.), Stanford University Medical Center, CA. richard.leigh@nih.gov.
Richard
R
Leigh
From the Neuro Vascular Brain Imaging Unit (R.L.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Stanford Stroke Center (S.C., G.W.A., M.G.L.), Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA; Department of Medicine and Neurology (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Australia; and Department of Radiology (M.P.M.), Stanford University Medical Center, CA.
Søren
S
Christensen
From the Neuro Vascular Brain Imaging Unit (R.L.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Stanford Stroke Center (S.C., G.W.A., M.G.L.), Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA; Department of Medicine and Neurology (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Australia; and Department of Radiology (M.P.M.), Stanford University Medical Center, CA.
Bruce C V
BC
Campbell
From the Neuro Vascular Brain Imaging Unit (R.L.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Stanford Stroke Center (S.C., G.W.A., M.G.L.), Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA; Department of Medicine and Neurology (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Australia; and Department of Radiology (M.P.M.), Stanford University Medical Center, CA.
Michael P
MP
Marks
From the Neuro Vascular Brain Imaging Unit (R.L.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Stanford Stroke Center (S.C., G.W.A., M.G.L.), Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA; Department of Medicine and Neurology (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Australia; and Department of Radiology (M.P.M.), Stanford University Medical Center, CA.
Gregory W
GW
Albers
From the Neuro Vascular Brain Imaging Unit (R.L.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Stanford Stroke Center (S.C., G.W.A., M.G.L.), Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA; Department of Medicine and Neurology (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Australia; and Department of Radiology (M.P.M.), Stanford University Medical Center, CA.
Maarten G
MG
Lansberg
D000368:Aged; D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging* / Q000378:metabolism*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005682:Gadolinium / Q000378:metabolism; D006406:Hematoma / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D018579:Patient Selection; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging
D005682:Gadolinium