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Abstract
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.
GLOSSARY
- BBB=
- blood–brain barrier;
- BBPI=
- blood–brain permeability image;
- DSC=
- dynamic susceptibility contrast;
- DWI=
- diffusion-weighted imaging;
- ECASS=
- European Cooperative Acute Stroke Study;
- GRE=
- gradient echo;
- HI=
- hemorrhagic infarct;
- ICH=
- intracranial hemorrhage;
- PH=
- parenchymal hematoma;
- PWI=
- perfusion-weighted imaging;
- ROC=
- receiver operator characteristic;
- ROI=
- region of interest;
- tPA=
- tissue plasminogen activator
Footnotes
DEFUSE 2 coinvestigators are listed on the Neurology® Web site at Neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received December 4, 2015.
- Accepted in final form April 5, 2016.
- © 2016 American Academy of Neurology
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