New imaging method can predict the risk of post-treatment brain hemorrhage after stroke ;
In a study of stroke patients, researchers confirmed through MRI brain scans that there was an association between the degree of disturbance of the barrier protective blood-brain and the severity of bleeding after therapy invasive stroke. The results of the National Institutes of Health funded study were published in neurology .
These findings are part of the diffusion and perfusion image analysis for understanding the movement Evolution (calm) -2 study, which was designed to see how MRIs can help determine what patients are subject to the following endovascular therapy ischemic stroke caused by a clot that blocks blood flow to the brain. Endovascular treatment addresses the ischemic clot itself, either by removing it or break it with a stent.
The blood-brain barrier is a layer of cells that protects the brain from harmful molecules that pass through the bloodstream. After the stroke, the barrier is broken, becoming permeable and loss of control over what gets into the brain.
“The biggest impact of this research is that information MRI routinely collected in a number of hospitals and research centers of stroke can inform the treating physicians in the risk of bleeding,” said Richard Leigh, MD, a scientist at the NIH National Institute of neurological disorders and Stroke (NINDS) and one of the study authors.
In this study, brain scans were obtained from more than 100 patients before undergoing endovascular therapy within 12 hours of stroke onset. Dr. Leigh and his team obtained images of defusing-2 researchers.
Using a new method of image processing, the group of Dr. Leigh was able to obtain detailed measurements of the extent to which the blood-brain barrier is interrupted after a stroke. Combining these data with those obtained in defusing-2 study revealed that large degrees of alteration of the blood-brain barrier were associated with severe bleeding after endovascular therapy. Wide breakdown of the blood brain barrier associated with parenchymal hematoma, a form of bleeding in the brain that carries the greatest risk to the patient. Moreover, the results showed a relationship between the location of blood brain barrier damage and cerebral hemorrhage posttreatment.
ischemic stroke patients are receiving increasingly combination therapy endovascular treatment along with an intravenous drug known as tissue plasminogen activator (t-PA), to effectively break clots in the brain. However, bleeding in the damaged brain tissue is a serious complication of both acute stroke therapies. t-PA has proven to be most effective when administered within a few hours of stroke onset, but the window of treatment for endovascular therapy is unknown.
“With the increasing accuracy of brain imaging technology, researchers are able to get a detailed view of what is happening in the brain during a stroke. Innovators, such as calming-2 studies, can help patients and their doctors make more informed decisions about health care, “said Walter Koroshetz, MD, director of the NINDS.
According to the authors, the review blood-brain barrier interruption brain images can potentially help doctors identify patients likely to benefit from endovascular therapy. “It’s too early to say how these images will be able to help guide clinical decisions, but can expand our thinking about stroke, especially when it comes to expanding treatment options for this disease which can have devastating consequences “said Dr. Leigh.
The trial distend-3 is currently underway, in which researchers will use the image data for selecting patients for endovascular therapy until 16 hours after stroke onset . recovery of patients will be closely monitored for three months after treatment.
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Posted in: Neuroscience