Francesco Arba1, Vanessa Palumbo2, Jean-Martin Boulanger3, Giovanni Pracucci4, Domenico Inzitari4, Alastair M Buchan5, Michael D Hill6. 1. NEUROFARBA Department, University of Florence, Florence, Italy francesco.arba@unifi.it. 2. Stroke Unit and Neurology, Careggi Hospital, Florence, Italy. 3. Department of Medical Imaging, University of Toronto, Toronto, Canada. 4. NEUROFARBA Department, University of Florence, Florence, Italy. 5. Acute Stroke Program, Department of Medicine and Clinical Geratology, University of Oxford, Oxford, UK. 6. Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
Abstract
BACKGROUND: The effect of preexisting small vessel disease on outcomes of patients with ischemic stroke treated with i.v. thrombolysis is not fully understood. AIM: We aim to investigate the effect of combined leukoaraiosis and lacunes as detected on unenhanced brain computer tomography at baseline on clinical outcomes after i.v. thrombolysis. METHODS: We analyzed data from the Canadian Alteplase for Stroke Effectiveness Study. Small vessel disease was assessed on baseline computer tomography rating for leukoaraiosis and lacunes. We dichotomized the burden of small vessel disease to "absent or moderate" and "severe." Clinical outcomes at 90 days included excellent outcome (mRS = 0-1), good outcome (mRS = 0-2), and the occurrence of symptomatic intracerebral hemorrhage. Sensitivity analysis was performed on two age groups (≤80 versus >80). We ran logistic regression adjusting for confounders to evaluate independent effect of small vessel disease on outcomes. RESULTS: There were 820 patients with available brain computer tomography with mean age (±SD) of 71.3 (±13.2), 455 (55.5%) were male. Of these, 123 (15%) patients had severe small vessel disease at baseline. Age group analysis revealed significant associations of small vessel disease only in patients aged ≤80. After adjustment for confounders, presence of severe small vessel disease reduced the chances of both excellent (OR = 0.42, 95% CI = 0.24-0.74) and good outcome (OR = 0.35, 95% CI = 0.21-0.58) and with an increased risk of symptomatic intracerebral hemorrhage (OR = 5.91; 95% CI = 2.40-14.57). CONCLUSION: When considered together as radiological expressions of small vessel disease, presence and severity of severe leukoaraiosis and lacunes on baseline computer tomography scan are associated with poor clinical outcomes in patients treated with i.v. thrombolysis.
BACKGROUND: The effect of preexisting small vessel disease on outcomes of patients with ischemic stroke treated with i.v. thrombolysis is not fully understood. AIM: We aim to investigate the effect of combined leukoaraiosis and lacunes as detected on unenhanced brain computer tomography at baseline on clinical outcomes after i.v. thrombolysis. METHODS: We analyzed data from the Canadian Alteplase for Stroke Effectiveness Study. Small vessel disease was assessed on baseline computer tomography rating for leukoaraiosis and lacunes. We dichotomized the burden of small vessel disease to "absent or moderate" and "severe." Clinical outcomes at 90 days included excellent outcome (mRS = 0-1), good outcome (mRS = 0-2), and the occurrence of symptomatic intracerebral hemorrhage. Sensitivity analysis was performed on two age groups (≤80 versus >80). We ran logistic regression adjusting for confounders to evaluate independent effect of small vessel disease on outcomes. RESULTS: There were 820 patients with available brain computer tomography with mean age (±SD) of 71.3 (±13.2), 455 (55.5%) were male. Of these, 123 (15%) patients had severe small vessel disease at baseline. Age group analysis revealed significant associations of small vessel disease only in patients aged ≤80. After adjustment for confounders, presence of severe small vessel disease reduced the chances of both excellent (OR = 0.42, 95% CI = 0.24-0.74) and good outcome (OR = 0.35, 95% CI = 0.21-0.58) and with an increased risk of symptomatic intracerebral hemorrhage (OR = 5.91; 95% CI = 2.40-14.57). CONCLUSION: When considered together as radiological expressions of small vessel disease, presence and severity of severe leukoaraiosis and lacunes on baseline computer tomography scan are associated with poor clinical outcomes in patients treated with i.v. thrombolysis.
Authors: Lester Y Leung; Traci M Bartz; Kenneth Rice; James Floyd; Bruce Psaty; Jose Gutierrez; W T Longstreth; Kenneth J Mukamal Journal: Arterioscler Thromb Vasc Biol Date: 2017-06-29 Impact factor: 8.311
Authors: Francesco Arba; Benedetta Piccardi; Vanessa Palumbo; Betti Giusti; Patrizia Nencini; Anna Maria Gori; Alice Sereni; Mascia Nesi; Giovanni Pracucci; Giorgio Bono; Paolo Bovi; Enrico Fainardi; Domenico Consoli; Antonia Nucera; Francesca Massaro; Giovanni Orlandi; Francesco Perini; Rossana Tassi; Maria Sessa; Danilo Toni; Rosanna Abbate; Domenico Inzitari Journal: Transl Stroke Res Date: 2018-04-23 Impact factor: 6.829