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Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke.

AbstractOBJECTIVES:
To evaluate whether the presence of leukoaraiosis or multiple lacunes is associated with symptomatic intracerebral hemorrhage (ICH) and 90-day outcome after thrombolytic treatment with tissue plasminogen activator (tPA).
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.
AuthorsV Palumbo, J M Boulanger, M D Hill, D Inzitari, A M Buchan,
JournalNeurology (Neurology) Vol. 68 Issue 13 Pg. 1020-4 (Mar 27 2007) ISSN: 1526-632X [Electronic] United States
PMID17389306 (Publication Type: Journal Article)
Chemical References
  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
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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