In a study of stroke patients, researchers used brain magnetic resonance imaging (MRI) to confirm the association between the degree of damage to the protective blood-brain barrier in the brain and severe bleeding after aggressive stroke therapy. Research results funded by the National Institutes of Health have been published in Neurology.
These findings are part of a study of the role of diffusion and perfusion imaging in assessing the progression of stroke (DEFUSE). The purpose of this study is to discover how MRI can help determine whether a patient is receiving an ischemic stroke due to a blocked blood flow to the brain. Endovascular treatment. The goal of endovascular therapy is to cause the ischemic thrombus itself, either to remove it or to break it with an intravascular stent.
The blood-brain barrier is a layer of cells that block harmful analysis from entering the brain through the bloodstream, thereby protecting the brain. After a stroke, this barrier will be damaged, and the permeability will become stronger, so you can't control the substances that enter the brain.
Dr. Richard Leigh, a scientist at the NIH National Institute of Neurological Disorders and Stroke (NINDS), said. The biggest impact of this research is to provide people with some information. MRI scan data is often used in many research hospitals or stroke centers to help doctors understand the risk of bleeding.
In this study, data were collected from more than 100 patients who underwent intrathoracic brain scans within 12 hours of stroke onset. Dr. Leigh and his team obtained scan data from DEFUSE-2 researchers.
Dr. Leigh's research team used new image processing techniques to obtain detailed data on the extent of blood-brain barrier damage after stroke. Combining the data obtained with the data from the DEFUSE-2 study, it was found that large-scale blood-brain barrier damage was associated with severe bleeding after endovascular therapy. Extensive damage to the blood-brain barrier is associated with parenchyma edema, which is the most dangerous form of bleeding in the brain for patients. In addition, the results also show a link between the location of the blood-brain barrier injury and post-treatment cerebral hemorrhage.
An increasing number of patients with ischemic stroke receive combination therapy, namely endovascular therapy combined with intravenous tissue plasminogen activator (t-PA), which effectively removes brain blockages. However, damaged brain tissue hemorrhage is a serious complication of both aggressive stroke treatments. t-PA is most effective within a few hours of onset of stroke, but the time window for treatment of endovascular therapy is unknown.
According to Dr. Walter Koroshetz, head of NINDS, as brain imaging technology develops more and more accurately, researchers can get details of the brain during a stroke. Innovative research like DEFUSE-2 can help patients and doctors make more informed decisions about treatments.
According to the authors, the degree of damage to the blood-brain barrier based on brain imaging may help doctors determine whether patients can benefit from endovascular therapy. While it's not yet known how these imaging techniques can be used to understand clinical decisions, these techniques can expand our understanding of strokes, especially when we want to make treatment options for the disease that have serious sequelae.
The DEFUSE-3 trial is currently underway and researchers will use imaging techniques to screen patients who are eligible for endovascular therapy 16 hours after the onset of stroke. The recovery of the patient will be closely monitored 3 months after treatment.
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