Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis
- 481 Downloads
Severity of vascular damage of white matter may predict hemorrhagic transformation (HT). We assess the relationship between leukoaraiosis (LA) severity and the type of hemorrhagic transformation in elderly patients treated with thrombolysis.
We retrospectively analyzed the clinical data and pretreatment magnetic resonance imaging (MRI) of 180 consecutive ischemic stroke patients aged over 75 years. LA severity was graded according to the Fazekas scale, and acute diffusion-weighted-imaging (DWI) lesion volumes were semi-automatically outlined. Predictors of hemorrhagic infarction (HI) and parenchymal hemorrhage (PH) were identified using logistic regression analysis and exact multinomial logistic analysis.
HT occurred in 31 patients (17 %). Baseline National Institute of Health Stroke Score (NIHSS; p = 0.008), severe LA (p = 0.02), and diffusion lesion volume (p = 0.02) were predictors of HT in univariable logistic regression. Adjusted to lesion volume and baseline NIHSS score, exact multinomial logistic analysis showed that severe LA was the only independent predictor of parenchymal hemorrhage (p = 0.03).
In elderly patients, LA severity better predicts parenchymal hemorrhage than infarct size.
KeywordsMagnetic resonance imaging Elderly Ischemic stroke Leucoaraiosis Thrombolysis
White matter hyperintensity
National Institute of Health Stroke Score
Magnetic resonance imaging
Tissue plasminogen activator
Compliance with ethical standards
We declare that all human studies have been approved [data from a regional emergency stroke network health registry in the Rhône Valley, France—RESUVAL Stroke Network—with 5 stroke units (one academic stroke unit and 4 non-academic stroke units), covering a population of 3 million people authorized by the French Ministry of Healthcare, Registration number E-2012-069] and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.
Conflict of interest
We declare that we have no conflict of interest.
- 5.Mishra NK, Ahmed N, Andersen G, Egido JA, Lindsberg PJ, Ringleb PA et al (2010) Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive. BMJ 23:341–c604Google Scholar
- 6.Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E et al (2014) Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 384(9958):1929–35CrossRefPubMedPubMedCentralGoogle Scholar
- 7.IST-3 collaborative group (2015) Association between brain imaging signs, early and late outcomes, and response to intravenous alteplase after acute ischaemic stroke in the third International Stroke Trial (IST-3): secondary analysis of a randomised controlled trial. Lancet Neurol 14(5):485–96CrossRefGoogle Scholar
- 23.Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D et al (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 352:1245–1251CrossRefPubMedGoogle Scholar
- 25.Kaffashian S, Tzourio C, Zhu YC, Mazoyer B, Debette S (2016) Differential effect of white-matter lesions and covert brain infarcts on the risk of ischemic stroke and intracerebral hemorrhage. Stroke 47(7):1923–1925Google Scholar
- 28.Kahles T, Foerch C, Sitzer M, Schroeter M, Steinmetz H, Rami A et al (2005) Tissue plasminogen activator mediated blood–brain barrier damage in transient focal cerebral ischemia in rats: relevance of interactions between thrombotic material and thrombolytic agent. Vasc Pharmacol 43:254–259CrossRefGoogle Scholar
- 29.Albers GW, Thijs VN, Wechsler L, for the DEFUSE Investigators et al (2006) Magnetic resonance imaging profiles predict clinical response to early reperfusion: the Diffusion and Perfusion Imaging Evaluation For Understanding Stroke Evolution (DEFUSE) study. Ann Neurol 60:508–517CrossRefPubMedGoogle Scholar