Blood–brain barrier leakage and hemorrhagic transformation: The Reperfusion Injury in Ischemic StroKe (RISK) study

• DOI: 10.1111/ene.14985
• Publication Date: 2021-06-18T14:59:25Z
• Authors: Francesco Arba; Benedetta Piccardi; Vanessa Palumbo; Silvia Biagini; Francesco Galmozzi; Veronica Iovene; Alessio Giannini; Giuseppe Dario Testa; Alessandro Sodero; Mascia Nesi; Davide Gadda; Marco Moretti; Maria Lamassa; Francesca Pescini; Anna Poggesi; Cristina Sarti; Stefania Nannoni; Giovanni Pracucci; Nicola Limbucci; Sergio Nappini; Leonardo Renieri; Stefano Grifoni; Enrico Fainardi; Domenico Inzitari; Patrizia Nencini
• Keywords: Interquartile range; Stroke

In patients with acute ischemic stroke treated reperfusion therapy we aimed to evaluate whether pretreatment blood-brain barrier (BBB) leakage is associated subsequent hemorrhagic transformation (HT).We prospectively screened intravenous thrombolysis and/or endovascular treatment. Before treatment, each patient received computed tomography (CT), CT angiography, and perfusion. We assessed BBB within the area using volume transfer constant (Ktrans ) value. Our primary outcome was relevant HT, defined as infarction type 2 or parenchymal hemorrhage 1 2. evaluated independent associations between HT logistic regression, adjusting for age, sex, baseline severity, Alberta Stroke Program Early Score (ASPECTS) ≥ 6, treatment type, onset-to-treatment time.We enrolled 171 available assessment of leakage. The patients' mean (±SD) age 75.5 (±11.8) years, 86 (50%) were men, median (interquartile range) National Institutes Health Scale score 18 (12-23). A total 32 (18%) thrombolysis, 102 (60%) underwent direct 37 (22%) both. Patients (N = 31;18%) had greater 0.77 vs. 0.60; p 0.027). After adjustment in regression model, found that both a more than twofold risk (odds ratio [OR] 2.50; 95% confidence interval [CI] 1.03-6.03 per Ktrans point increase; OR 2.34; CI 1.06-5.17 values > 0.63 [mean value]) symptomatic intracerebral (OR 4.30; 1.13-13.77 increase).Pretreatment before may help identify at HT.