Early Blood‐Brain Barrier Disruption after Mechanical Thrombectomy in Acute Ischemic Stroke. Issue 3 (27th February 2018)

• Record Type: Journal Article
• Authors: Shi, Zhong‐Song; Duckwiler, Gary R.; Jahan, Reza; Tateshima, Satoshi; Szeder, Viktor; Saver, Jeffrey L.; Kim, Doojin; Sharma, Latisha K.; Vespa, Paul M.; Salamon, Noriko; Villablanca, J. Pablo; Viñuela, Fernando; Feng, Lei; Loh, Yince; Liebeskind, David S.
• Is Part Of: Journal of neuroimaging. Volume 28:Issue 3(2018)
• Page Start: 283
• Page End: 288
• Publication Date: 2018-02-27
• Subjects: Acute ischemic stroke -- endovascular treatment -- mechanical thrombectomy -- blood‐brain barrier disruption -- outcome; Diagnostic imaging -- Periodicals; Nervous system -- Diseases -- Diagnosis -- Periodicals; Imagerie pour le diagnostic -- Périodiques; Système nerveux -- Maladies -- Diagnostic -- Périodiques; Imagerie médicale; Neuroimagerie; Neurologie; Système nerveux; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.804754
• DOI: 10.1111/jon.12504
• Languages: English
• ISSNs: 1051-2284

Abstract

ABSTRACT: BACKGROUND AND PURPOSE: The impact of blood‐brain barrier (BBB) disruption can be detected by intraparenchymal hyperdense lesion on the computed tomography (CT) scan after endovascular stroke therapy. The purpose of this study was to determine whether early BBB disruption predicts intracranial hemorrhage and poor outcome in patients with acute ischemic stroke treated with mechanical thrombectomy. METHODS: We analyzed patients with anterior circulation stroke treated with mechanical thrombectomy and identified BBB disruption on the noncontrast CT images immediately after endovascular treatment. Follow‐up CT or magnetic resonance imaging scan was performed at 24 hours to assess intracranial hemorrhage. We dichotomized patients into those with moderate BBB disruption versus those with minor BBB disruption and no BBB disruption. We evaluated the association of moderate BBB disruption after mechanical thrombectomy with intracranial hemorrhage and clinical outcomes. RESULTS: Moderate BBB disruption after mechanical thrombectomy was found in 56 of 210 patients (26.7%). Moderate BBB disruption was independently associated with higher rates of hemorrhagic transformation (OR 25.33; 95% CI 9.93‐64.65; P < .001), parenchymal hematoma (OR 20.57; 95% CI 5.64‐74.99; P < .001), and poor outcome at discharge (OR 2.35; 95% CI 1.09‐5.07; P = .03). The association of BBB disruption with intracranial hemorrhage remained in patients with successful reperfusion after mechanical thrombectomy. The location of BBB disruption was not associated with intracranial hemorrhage and poor outcome. CONCLUSIONS: Moderate BBB disruption is common after mechanical thrombectomy in a quarter of patients with acute ischemic stroke and increases the risk of intracranial hemorrhage and poor outcome.