BACKGROUND AND PURPOSE: In patients with acute ischemic stroke treated with reperfusion therapy we aimed to evaluate whether pre-treatment blood-brain-barrier (BBB) leakage is associated with subsequent hemorrhagic transformation (HT). METHODS: We prospectively screened patients with acute ischemic stroke treated with intravenous thrombolysis and/or endovascular treatment. Before treatment, each patient received Computed Tomography (CT), CT angiography, and CT perfusion. We assessed pre-treatment BBB leakage within the ischemic area using volume transfer constant (Ktrans ). Our primary outcome was relevant HT, defined as hemorrhagic infarction type 2 or parenchymal hemorrhage type 1 or 2. We evaluated independent associations between BBB leakage and HT with logistic regression adjusting for age, sex, baseline stroke severity, ASPECTS>=6, treatment type, and onset-to-treatment time. RESULTS: We enrolled 171 patients with available assessment of BBB leakage, mean (±SD) age 75.5 (±11.8) years, 86 (50%) males, and median (IQR) National Institutes of Health Stroke Scale of 18 (12-23). A total of 32 (18%) patients received intravenous thrombolysis, 102 (60%) underwent direct endovascular treatment, 37 (22%) both. Patients with relevant HT (N=31;18%) had higher mean BBB leakage (Ktrans 0.77 vs 0.60; p=0.027). After adjustment in the logistic regression model, we found that BBB leakage was associated with more than two-fold risk of relevant HT (OR=2.50; 95%CI=1.03-6.03 per Ktrans point-increase; OR=2.34; 95%CI=1.06-5.17 for Ktrans values>0.63 [mean BBB leakage value]) and with sICH (OR=4.30; 95%CI=1.13-13.77 per Ktrans point-increase). CONCLUSION: Pre-treatment BBB leakage before reperfusion therapy was associated with HT, and may help to identify patients at risk of HT. This article is protected by copyright. All rights reserved.
BACKGROUND AND PURPOSE: In patients with acute ischemic stroke treated with reperfusion therapy we aimed to evaluate whether pre-treatment blood-brain-barrier (BBB) leakage is associated with subsequent hemorrhagic transformation (HT). METHODS: We prospectively screened patients with acute ischemic stroke treated with intravenous thrombolysis and/or endovascular treatment. Before treatment, each patient received Computed Tomography (CT), CT angiography, and CT perfusion. We assessed pre-treatment BBB leakage within the ischemic area using volume transfer constant (Ktrans ). Our primary outcome was relevant HT, defined as hemorrhagic infarction type 2 or parenchymal hemorrhage type 1 or 2. We evaluated independent associations between BBB leakage and HT with logistic regression adjusting for age, sex, baseline stroke severity, ASPECTS>=6, treatment type, and onset-to-treatment time. RESULTS: We enrolled 171 patients with available assessment of BBB leakage, mean (±SD) age 75.5 (±11.8) years, 86 (50%) males, and median (IQR) National Institutes of Health Stroke Scale of 18 (12-23). A total of 32 (18%) patients received intravenous thrombolysis, 102 (60%) underwent direct endovascular treatment, 37 (22%) both. Patients with relevant HT (N=31;18%) had higher mean BBB leakage (Ktrans 0.77 vs 0.60; p=0.027). After adjustment in the logistic regression model, we found that BBB leakage was associated with more than two-fold risk of relevant HT (OR=2.50; 95%CI=1.03-6.03 per Ktrans point-increase; OR=2.34; 95%CI=1.06-5.17 for Ktrans values>0.63 [mean BBB leakage value]) and with sICH (OR=4.30; 95%CI=1.13-13.77 per Ktrans point-increase). CONCLUSION: Pre-treatment BBB leakage before reperfusion therapy was associated with HT, and may help to identify patients at risk of HT. This article is protected by copyright. All rights reserved.