Early Blood‐Brain Barrier Disruption after Mechanical Thrombectomy in Acute Ischemic Stroke

• Published in: Journal of neuroimaging Vol. 28; no. 3; pp. 283 - 288
• Main 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.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-05-2018
• Subjects: Acute ischemic stroke; Blood-brain barrier; blood‐brain barrier disruption; Brain; Cardiovascular system; Computed tomography; Disruption; endovascular treatment; Health risks; Hematoma; Hemorrhage; Ischemia; Magnetic resonance imaging; mechanical thrombectomy; Neuroimaging; outcome; Patients; Reperfusion; Stroke; mechanical thrombectomy; blood-brain barrier disruption; endovascular treatment; Acute ischemic stroke; outcome
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/jon.12504

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.