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Clinical Trial
. 2016 Jul 19;87(3):263-9.
doi: 10.1212/WNL.0000000000002862. Epub 2016 Jun 17.

Pretreatment blood-brain barrier disruption and post-endovascular intracranial hemorrhage

Richard Leigh  1 , Søren Christensen  2 , Bruce C V Campbell  2 , Michael P Marks  2 , Gregory W Albers  2 , Maarten G Lansberg  2 ; DEFUSE 2 Investigators
Collaborators, Affiliations
Clinical Trial

Pretreatment blood-brain barrier disruption and post-endovascular intracranial hemorrhage

Richard Leigh et al. Neurology. .

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.

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Figures

Figure 1
Figure 1. A comparison of the pretreatment blood–brain barrier disruption with the posttreatment hemorrhage grade
(A) Boxplots for the mean permeability grouped by no-ICH, HI1 + HI2, and PH1 + PH2. (B) Boxplots for each group individually. The red line on both graphs is the 21% threshold identified in the prior study as potentially being predictive of PH. HI = hemorrhagic Infarction; ICH = intracranial hemorrhage; PH = parenchymal hematoma.
Figure 2
Figure 2. Examples of pretreatment blood–brain barrier disruption and posttreatment ICH
This figure shows examples of the blood–brain permeability imaging of 4 patients who went on to develop ICH after endovascular therapy. The first column shows the acute DWI scans with the color permeability map overlaid on top. The second column shows the follow-up GRE images with ICH. The third column has the pretreatment color permeability maps overlaid on the follow-up GRE. (A) This patient had a mean permeability derangement of 28% and experienced a PH. (B) This patient had a lower mean permeability derangement of 9% but still experienced a PH. (C) This patient had a mean permeability of 18%, thus was below the PH threshold, and only had HI. (D) This patient had a very high mean permeability of 41% but did not have PH, only HI. DWI = diffusion-weighted imaging, GRE = gradient recalled echo; HI = hemorrhagic infarction; ICH = intracranial hemorrhage; PH = parenchymal hematoma.
See this image and copyright information in PMC

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