Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Province Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, China.
J Neuroimaging. 2018 May;28(3):283-288. doi: 10.1111/jon.12504. Epub 2018 Feb 27.
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.
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.
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.
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.
血管内治疗后，脑实质内高密度病灶可在 CT 扫描上检测到血脑屏障（BBB）破坏。本研究旨在确定机械取栓治疗的急性缺血性卒中患者，早期 BBB 破坏是否能预测颅内出血和不良预后。
我们分析了接受机械取栓治疗的前循环卒中患者，并在血管内治疗后立即在非对比 CT 图像上识别 BBB 破坏。在 24 小时进行随访 CT 或磁共振成像扫描，以评估颅内出血。我们将患者分为中度 BBB 破坏与轻度 BBB 破坏和无 BBB 破坏两组。评估机械取栓后中度 BBB 破坏与颅内出血和临床结局的相关性。
210 例患者中有 56 例（26.7%）机械取栓后出现中度 BBB 破坏。中度 BBB 破坏与较高的出血转化率独立相关（OR 25.33；95%CI 9.93-64.65；P<0.001）、实质血肿（OR 20.57；95%CI 5.64-74.99；P<0.001）和出院时不良结局（OR 2.35；95%CI 1.09-5.07；P=0.03）相关。机械取栓成功再灌注后，BBB 破坏与颅内出血仍存在相关性。BBB 破坏的位置与颅内出血和不良预后无关。
急性缺血性卒中患者机械取栓后四分之一出现中度 BBB 破坏，增加了颅内出血和不良预后的风险。
