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Updated: Mar 19, 2026
Rat Model of Blood-brain Barrier Disruption to Allow Targeted Neurovascular Therapeutics
Published on: November 30, 2012
Pretreatment blood-brain barrier disruption and post-endovascular intracranial hemorrhage
Richard Leigh1, Søren Christensen2, Bruce C V Campbell2
1From the Neuro Vascular Brain Imaging Unit (R.L.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Stanford Stroke Center (S.C., G.W.A., M.G.L.), Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA; Department of Medicine and Neurology (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Australia; and Department of Radiology (M.P.M.), Stanford University Medical Center, CA. richard.leigh@nih.gov.
Objective:
This study sought to confirm the relationship between the degree of blood-brain barrier (BBB) damage and the severity of intracranial hemorrhage (ICH) in a population of patients who received endovascular therapy.
Methods:
The degree of BBB disruption on pretreatment MRI scans was analyzed, blinded to follow-up data, in the DEFUSE 2 cohort in which patients had endovascular therapy within 12 hours of stroke onset. BBB disruption was compared with ICH grade previously established by the DEFUSE 2 core lab. A prespecified threshold for predicting parenchymal hematoma (PH) was tested.
Results:
Of the 108 patients in the DEFUSE 2 trial, 100 had adequate imaging and outcome data and were included in this study; 24 developed PH. Increasing amounts of BBB disruption on pretreatment MRIs was associated with increasing severity of ICH grade (p = 0.004). BBB disruption on the pretreatment scan was associated with PH (p = 0.020) with an odds ratio for developing PH of 1.69 for each 10% increase in BBB disruption (95% confidence interval 1.09-2.64), although a reliably predictive threshold was not identified.
Conclusions:
The amount of BBB disruption on pretreatment MRI is associated with the severity of ICH after acute intervention. This relationship has now been identified in patients receiving IV, endovascular, and combined therapies. Further study is needed to determine its role in guiding treatment.
Insights
Blood-brain barrier (BBB) damage on MRI scans correlates with the severity of intracranial hemorrhage (ICH) after endovascular therapy. This finding, observed in stroke patients, suggests BBB integrity is crucial for treatment outcomes.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Intracranial hemorrhage (ICH) severity is a critical factor in stroke outcomes.
- Endovascular therapy is a key treatment for acute ischemic stroke.
- Understanding factors influencing ICH post-intervention is vital.
Purpose of the Study:
- To confirm the association between blood-brain barrier (BBB) damage and ICH severity.
- To investigate this relationship in patients undergoing endovascular therapy for stroke.
Main Methods:
- Analysis of pretreatment MRI scans from the DEFUSE 2 cohort.
- Assessment of BBB disruption blinded to follow-up data.
- Comparison of BBB disruption with established ICH grades and parenchymal hematoma (PH) development.
Main Results:
- A significant correlation was found between increased BBB disruption and higher ICH grades (p = 0.004).
- BBB disruption predicted PH development (p = 0.020), with an odds ratio of 1.69 per 10% increase.
- A precise predictive threshold for PH was not identified.
Conclusions:
- Pretreatment BBB disruption on MRI is linked to ICH severity following acute intervention.
- This association is consistent across IV, endovascular, and combined stroke therapies.
- Further research is warranted to explore BBB's role in guiding treatment decisions.
