With the use of MR brain scans, researchers from NIH’s National Institute of Neurological Disorders and Stroke (NINDS) have uncovered a link between “disruption” in the blood-brain barrier and bleeding in the brain after endovascular therapy for stroke patients.

The Blood-brain barrier (BBB), a layer of cells that protect the brain from harmful molecules passing through the bloodstream, gets disrupted after a stroke, becomes permeable, and loses control over what gets into the brain.

In the study, 100 brain scans were collected from patients within 12 hours of the patient having a stroke and before they underwent endovascular therapy. The researchers used MR to obtain measurements of how severely the blood-brain barrier was disrupted after the stroke.
They combined their collected data with findings from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE)-2 study, a study to see how MRs can help determine which patients undergo endovascular therapy, and found that a large breakdown of the blood-brain barrier was associated with parenchymal hematoma, a form of bleeding in the brain that is considered the greatest risk for a patient.

“The method used in our recent study extracts a new type of information from a type of MRI that is used for a different purpose,” Dr. Richard Leigh, a scientist at NIH’s NINDS and the author of the study, told HCB News.

“[This type of imaging] uses a contrast agent called gadolinium,” he said. “As the gadolinium passes through the blood vessels in the brain, we are able to determine if there is a deficiency in blood flow, which is the hallmark of an ischemic stroke. However, if the blood-brain barrier…is disrupted, then the gadolinium can cross into the brain.”

According to the authors, examining BBB disruption on brain images may potentially help doctors identify patients who are not likely to benefit from endovascular therapy.

“We have identified a new way to assess the integrity of the BBB and found that it has clinical implications for stroke patients,” said Leigh. “This is a new piece of information we have not previously had when deciding how safe a stroke treatment is.”

Leigh also said in a statement that the biggest impact of the research is to show that information from MR scans that are collected at research hospitals and stroke centers can inform physicians of a patient’s risk of bleeding.

Currently, the DEFUSE-3 trial is underway, where researchers will use imaging data to select patients for endovascular therapy.

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