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2014 ; 45
(7
): 2030-5
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Pretreatment blood-brain barrier damage and post-treatment intracranial
hemorrhage in patients receiving intravenous tissue-type plasminogen activator
#MMPMID24876245
Leigh R
; Jen SS
; Hillis AE
; Krakauer JW
; Barker PB
Stroke
2014[Jul]; 45
(7
): 2030-5
PMID24876245
show ga
BACKGROUND AND PURPOSE: Early blood-brain barrier damage after acute ischemic
stroke has previously been qualitatively linked to subsequent intracranial
hemorrhage (ICH). In this quantitative study, it was investigated whether the
amount of blood-brain barrier damage evident on pre-tissue-type plasminogen
activator MRI scans was related to the degree of post-tissue-type plasminogen
activator ICH in patients with acute ischemic stroke. METHODS: Analysis was
performed on a database of patients with acute ischemic stroke provided by the
Stroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive
(VISTA) Imaging Investigators. Patients with perfusion-weighted imaging
lesions>10 mL and negative gradient-recalled echo imaging before intravenous
tissue-type plasminogen activator were included. Postprocessing of the
perfusion-weighted imaging source images was performed to estimate changes in
blood-brain barrier permeability within the perfusion deficit relative to the
unaffected hemisphere. Follow-up gradient-recalled echo images were reviewed for
evidence of ICH and divided into 3 groups according to European Cooperative Acute
Stroke Study (ECASS) criteria: no hemorrhage, hemorrhagic infarction, and
parenchymal hematoma. RESULTS: Seventy-five patients from the database met the
inclusion criteria, 28 of whom experienced ICH, of which 19 were classified as
hemorrhagic infarction and 9 were classified as parenchymal hematoma. The mean
permeability (±SDs), expressed as an index of contrast leakage, was 17.0±8.8% in
the no hemorrhage group, 19.4±4.0% in the hemorrhagic infarction group, and
24.6±4.5% in the parenchymal hematoma group. Permeability was significantly
correlated with ICH grade in univariate (P=0.007) and multivariate (P=0.008)
linear regression modeling. CONCLUSIONS: A perfusion-weighted imaging-derived
index of blood-brain barrier damage measured before intravenous tissue-type
plasminogen activator is given is associated with the severity of ICH after
treatment in patients with acute ischemic stroke.