Abstract Background and aims There is limited data on the impact of blood-brain barrier disruption (BBBD) on outcome in patients with a large vessel occlusion (LVO). Methods Patients presenting to a primary stroke center with an LVO detected by MRI with perfusion weighted imaging (PWI) who were transferred to a comprehensive stroke center for thrombectomy were included in this study. RAPID software was used to identify the core infarct region of interest (ROI). PWI source images were used to detect contrast leakage due to BBBD as a percent signal change. The variable core BBBD (cBBBD) was calculated as the average of all leaky voxels in the core ROI. Good functional outcome (GFO) was defined as a mRS=2 and was compared with cBBBD using logistic regression. Results 291 patients were included; median age was 74 and 49% were female. The median NIHSS was 13, the mean core volume was 32.3 mL and the mean cBBBD was 2.11%. Increasing cBBBD was associated with a lower chance of achieving a GFO (OR 0.833, CI 0.742:0.936, p=0.002, n=279) indicating that for every one percent increase in cBBBD on arrival the odds of achieving a GFO three months later dropped by 17%. Increasing cBBBD was associated with an increased risk of death (OR 1.120, CI 1.003:1.250, p=0.042, n=279) indicating the probability of dying increased by 12% for every one percent increase in Conclusions In patients with LVO transferred for thrombectomy, pre-transfer BBB imaging was informative about functional outcome 3 months later. Conflict of interest Richard Leigh: nothing to disclose; Nefeli Valyraki: nothing to disclose; Frédérique Charbonneau: nothing to disclose; Manar Abomulay: nothing to disclose; Adrien ter Schiphorst: nothing to disclose; Adria Valls Carbo: nothing to disclose; Maria Hernández Pérez: nothing to disclose; Jean Marc Olivot: nothing to disclose; Pierre Seners: nothing to disclose
Leigh et al. (2026) studied this question.