Imaging method may help identify risk of brain bleeding following stroke

An analysis of patients who received endovascular therapy within 12 hours of stroke onset found that the amount of blood-brain barrier disruption on pretreatment MRIs was associated with the severity of intracranial hemorrhage.

Richard Leigh, MD, of the National Institute of Neurological Disorders and Stroke, and colleagues published their results online in Neurology on June 17.

“Examining blood-brain barrier disruption on brain images may potentially help doctors identify patients not likely to benefit from endovascular therapy,” the researchers said in a news release.

For this trial, the researchers evaluated 100 patients who enrolled in the DEFUSE-2 (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution-2) study. They received brain scans of patients before they underwent endovascular therapy.

By using a new image processing method, Leigh and his colleagues found that extensive disruption in the blood-brain barrier was associated with parenchymal hematoma. Of the patients, 24 developed parenchymal hematoma, a type of bleeding in the brain with the highest risk for patients.

The researchers said that the presence of blood-brain barrier disruption on the pretreatment scan was associated with parenchymal hematoma. The odds ratio for developing parenchymal hematoma was 1.69 for each 10 percent increase in blood-brain barrier disruption. However, they noted that “a reliably predictive threshold was not identified.”

“The biggest impact of this research is that information from MRI scans routinely collected at a number of research hospitals and stroke centers can inform treating physicians on the risk of bleeding,” Leigh said in a news release. “It is too early to say how these images will be able to help guide clinical decisions, but they can expand how we think about stroke, especially as we try to broaden treatment options for this disease that can have devastating consequences.”