Abstract | BACKGROUND:
Leukoaraiosis is associated with microhemorrhages on T(2)*-weighted magnetic resonance imaging of the brain. Such hemorrhages have been postulated to be responsible for symptomatic intracerebral hemorrhage (ICH) after thrombolytic treatment. We examined the relationship between small-vessel ischemic disease and symptomatic ICH within the NINDS rt-PA Stroke Study. METHODS: Baseline CT scans from the NINDS rt-PA Stroke Study were re-evaluated retrospectively by blinded expert CT readers using the van Swieten Score (vSS) for leukoaraiosis. The scale examined the severity of white-matter changes on 3 serial CT slices and graded separately for the 2 distinct regions anterior and posterior to the central sulcus: 0 = no lesion, 1 = partly involving the white matter, and 2 = extending up to the cortex. RESULTS: 603 CT scans were interpreted. The risk of symptomatic ICH increased with higher vSS in both the placebo and treatment groups. The absolute risk of symptomatic hemorrhage was 7.9% in the rt-PA-treated cohort among patients with severe white-matter disease (vSS = 3-4) versus 2.9% receiving placebo. Among severe leukoaraiosis patients (vSS = 3-4), no differential treatment effect was seen with rt-PA patients achieving better outcomes than placebo, modified Rankin score 0-1 in 31.6% of rt-PA-treated versus 14.7% of placebo-treated patients. CONCLUSION: The results from the present study do not support the concept that leukoaraiosis present on baseline noncontrast CT scanning is critical to thrombolysis decision making in the first 3 h from symptom onset. No clear leukoaraiosis threshold was identified below which no benefit or harm could be seen from intravenous rt-PA therapy.
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Authors | Andrew M Demchuk, Firosh Khan, Michael D Hill, Philip A Barber, Brian Silver, Suresh Patel, Steven R Levine, NINDS rt-PA Stroke Study Group |
Journal | Cerebrovascular diseases (Basel, Switzerland)
(Cerebrovasc Dis)
Vol. 26
Issue 2
Pg. 120-5
( 2008)
ISSN: 1421-9786 [Electronic] Switzerland |
PMID | 18560214
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Copyright | (c) 2008 S. Karger AG, Basel. |
Chemical References |
- Fibrinolytic Agents
- Recombinant Proteins
- Tissue Plasminogen Activator
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Topics |
- Decision Making
- Fibrinolytic Agents
(administration & dosage, adverse effects)
- Humans
- Infusions, Intravenous
- Intracranial Hemorrhages
(etiology)
- Leukoaraiosis
(complications, diagnostic imaging)
- Logistic Models
- Multicenter Studies as Topic
- Patient Selection
- Randomized Controlled Trials as Topic
- Recombinant Proteins
(administration & dosage)
- Retrospective Studies
- Risk Assessment
- Severity of Illness Index
- Stroke
(diagnostic imaging, drug therapy)
- Thrombolytic Therapy
(adverse effects)
- Time Factors
- Tissue Plasminogen Activator
(administration & dosage, adverse effects)
- Tomography, X-Ray Computed
- Treatment Outcome
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