Leukoaraiosis and risk of intracranial hemorrhage and outcome after stroke thrombolysis

Chun Ming Yang, Chien Ling Hung, Hui Chen Su, Huey Juan Lin, Chih Hung Chen, Chou Ching Lin, Han Hwa Hu, Sheng Hsiang Lin, Pi Shan Sung

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4 Citations (Scopus)

Abstract

Background The impact of leukoaraiosis on the risk of symptomatic intracerebral hemorrhage (SICH) after stroke thrombolysis is conflicting, and the data on Asian populations are lacking. Therefore, in this study, we assessed the association between leukoaraiosis and SICH, and the association between leukoaraiosis and the 90-day functional outcome in the Asian population. Methods Data were collected from a two-center prospective registry of acute ischemic stroke patients given intravenous tissue plasminogen activator between 2006 and 2014. A total of 614 pretreatment brain CT and 455 posttreatment MRI were retrospectively assessed using two different rating scales for the presence of leukoaraiosis. Outcome measures were the occurrence of SICH with three definitions and any hemorrhage after thrombolysis and functional outcome at 3 months. Results Of the 614 patients assessed, 30.3% showed severe leukoaraiosis on the baseline brain CT. The SICH rate was 4.6% - 7.2% based on different definitions, and overall, 24.9% of patients showed any post-tPA hemorrhage. No association was observed between the severity of leukoaraiosis and SICH, regardless of having used different leukoaraiosis rating scales or as assessment using different imaging modalities. However, severe leukoaraiosis was independently associated with poor functional outcome at 3 months (OR 1.96, 95% C1 1.24–3.11, P = 0.004) after adjustment for confounders. Conclusions Our results showed no association between leukoaraiosis and the risk of SICH. Although the presence of severe leukoaraiosis predicted a poor functional outcome after stroke, IV thrombolysis might not be withheld in acute ischemic stroke patients solely based on the presence of severe leukoaraiosis on pre-thrombolytic CT scans.

Original languageEnglish
Article numbere0196505
JournalPLoS One
Volume13
Issue number5
DOIs
Publication statusPublished - May 1 2018

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Keywords

  • Aged
  • Female
  • Humans
  • Intracranial Hemorrhages/complications
  • Leukoaraiosis/complications
  • Male
  • Middle Aged
  • Risk Factors
  • Stroke/complications
  • Thrombolytic Therapy/adverse effects
  • Tissue Plasminogen Activator/therapeutic use
  • Treatment Outcome

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Yang, C. M., Hung, C. L., Su, H. C., Lin, H. J., Chen, C. H., Lin, C. C., Hu, H. H., Lin, S. H., & Sung, P. S. (2018). Leukoaraiosis and risk of intracranial hemorrhage and outcome after stroke thrombolysis. PLoS One, 13(5), [e0196505]. https://doi.org/10.1371/journal.pone.0196505