Abstract | OBJECTIVES: METHODS: Data were from a Canadian national registry of thrombolyzed patients with ischemic stroke. A total of 820 scans were assessed, blind to clinical features, for the presence of severe vs no/moderate leukoaraiosis, and of multiple (>2) vs no/single lacunar infarcts. Logistic regression was used to determine if an independent interaction existed between the presence and degree of leukoaraiosis/lacunes and risk of symptomatic ICH, and to evaluate the predictive role of leukoaraiosis and lacunes in relation to 90-day outcome. RESULTS: An overall symptomatic ICH rate of 3.5% was observed. The rate of symptomatic ICH increased up to 10% in patients with severe leukoaraiosis and multiple lacunes. A significant association was observed between ICH risk and either severe leukoaraiosis (RR = 2.7 [95% CI 1.1 to 6.5]) or multiple lacunes (RR = 3.4 [95% CI 1.5 to 7.6]). Patients with multiple lacunes, but not leukoaraiosis, had higher mortality at 90 days compared to those with one or no lacunes (OR = 2.9, 95% CI 1.3 to 6.2, p = 0.008). No difference was observed in the good outcome rate among patients with and without leukoaraiosis or lacunes or both. CONCLUSION: The presence of small vessel disease on CT scan does not affect overall clinical outcome at 3 months in routine community use of tPA for ischemic stroke. A significant increase in the risk of symptomatic ICH is observed.
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Authors | V Palumbo, J M Boulanger, M D Hill, D Inzitari, A M Buchan, CASES Investigators |
Journal | Neurology
(Neurology)
Vol. 68
Issue 13
Pg. 1020-4
(Mar 27 2007)
ISSN: 1526-632X [Electronic] United States |
PMID | 17389306
(Publication Type: Journal Article)
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Chemical References |
- Fibrinolytic Agents
- Tissue Plasminogen Activator
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Topics |
- Acute Disease
(therapy)
- Aged
- Brain
(blood supply, drug effects, physiopathology)
- Brain Infarction
(complications, pathology, physiopathology)
- Brain Ischemia
(complications, drug therapy, physiopathology)
- Canada
- Cerebral Arteries
(drug effects, pathology, physiopathology)
- Cerebral Hemorrhage
(chemically induced, pathology, physiopathology)
- Cohort Studies
- Female
- Fibrinolytic Agents
(adverse effects)
- Humans
- Leukoaraiosis
(complications, pathology, physiopathology)
- Male
- Nerve Fibers, Myelinated
(pathology)
- Prospective Studies
- Retrospective Studies
- Risk Factors
- Stroke
(complications, drug therapy, physiopathology)
- Thrombolytic Therapy
(adverse effects)
- Tissue Plasminogen Activator
(adverse effects)
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