Blood-brain barrier disruption after cardiac surgery

J. G. Merino, L. L. Latour, A. Tso, K. Y. Lee, D. W. Kang, L. A. Davis, R. M. Lazar, K. A. Horvath, P. J. Corso, S. Warach

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Abstract

BACKGROUND AND PURPOSE: CNS complications are often seen after heart surgery, and postsurgical disruption of the BBB may play an etiologic role. The objective of this study was to determine the prevalence of MR imaging-detected BBB disruption (HARM) and DWI lesions after cardiac surgery. MATERIALS AND METHODS: All patients had an MRI after cardiac surgery. For half the patients (group 1), we administered gadolinium 24 hours after surgery and obtained high-resolution DWI and FLAIR images 24-48 hours later. We administered gadolinium to the other half (group 2) at the time of the postoperative scan, 2-4 days after surgery. Two stroke neurologists evaluated the images. RESULTS: Of the 19 patients we studied, none had clinical evidence of a stroke or delirium at the time of the gadolinium administration or the scan, but 9 patients (47%) had HARM (67% in group 1; 30% in group 2; P =.18) and 14 patients (74%) had DWI lesions (70% in group 1; 78% in group 2; P = 1.0). Not all patients with DWI lesions had HARM, and not all patients with HARM had DWI lesions (P =.56). CONCLUSIONS: Almost half the patients undergoing cardiac surgery have evidence of HARM, and three-quarters have acute lesions on DWI after surgery. BBB disruption is more prevalent in the first 24 hours after surgery. These findings suggest that MR imaging can be used as an imaging biomarker to assess therapies that may protect the BBB in patients undergoing heart surgery.

Original languageEnglish (US)
Pages (from-to)518-523
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume34
Issue number3
DOIs
Publication statusPublished - Mar 2013

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ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

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Merino, J. G., Latour, L. L., Tso, A., Lee, K. Y., Kang, D. W., Davis, L. A., ... Warach, S. (2013). Blood-brain barrier disruption after cardiac surgery. American Journal of Neuroradiology, 34(3), 518-523. https://doi.org/10.3174/ajnr.A3251