Top

Neurological Sciences

Published in:

Open Access 01-11-2020 | Stroke | Original Article

The relationship of leukoaraiosis, haemorrhagic transformation and prognosis at 3 months after intravenous thrombolysis in elderly patients aged ≥ 60 years with acute cerebral infarction

Authors: Xiaowei Liu, Jiatang Zhang, Chenglin Tian, Jun Wang

Published in: Neurological Sciences | Issue 11/2020

Abstract

Backgroud

As the elderly stroke population continues to increase, we will have to confront greater challenges regarding how to choose suitable patients to reduce thrombolysis-related bleeding events and accurately judge their prognosis. Therefore, we evaluated the relationship among leukoaraiosis (LA), haemorrhagic transformation (HT) and the prognosis at 3 months after intravenous (IV) thrombolysis in elderly patients aged ≥ 60 years with acute cerebral infarction (ACI).

Methods

We prospectively and consecutively chose 125 elderly patients aged ≥ 60 years with ACI who could accept and be suitable for IV recombinant tissue plasminogen activator (rtPA) after excluding 6 cases. Brain computed tomography(CT) was used to assess LA by using the modified Van Swieten scale (mVSS) before treatment and the modified Rankin scale (mRS) to appraise prognosis at 3 months after IV rtPA. Binary logistic regression was used to analyse the predictors of HT and the prognosis of ACI.

Results

Our data indicated that by brain CT, 26.4% of all patients showed severe LA, and the rate of HT and symptomatic intracranial haemorrhage (sICH) were 12.0% and 9.6%, respectively. Severe LA was evidently associated with HT (odds ratio [OR] 3.272, 95% confidence interval [CI] 1.010–10.598, P = 0.048) rather sICH (P > 0.05). Moreover, we also found that severe LA was associated with poor functional prognosis (OR 5.266, 95% CI 1.592–17.419, P = 0.006).

Conclusion

Our results showed that LA was associated with HT and adverse clinical prognosis rather sICH after IV rtPA in elderly patients aged ≥60 years with ACI. Although LA may increase the risk of bleeding but not fatal haemorrhage after IV thrombolysis, therefore, we should actively select an appropriate elderly population for thrombolytic treatment and have reasonable judgments on the outcomes.

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL, American Heart Association Stroke Council (2018) 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 49(3):e46–e110CrossRef

National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333(24):1581–1587CrossRef

Yaghi S, Boehme AK, Dibu J, Leon Guerrero CR, Ali S, Martin-Schild S, Sands KA, Noorian AR, Blum CA, Chaudhary S, Schwamm LH, Liebeskind DS, Marshall RS, Willey JZ (2015) Treatment and outcome of thrombolysis-related hemorrhage: a multicenter retrospective study. JAMA Neurol 72(12):1451–1457CrossRef

Choi JH, Bae HJ, Cha JK (2011) Leukoaraiosis on magnetic resonance imaging is related to long-term poor functional outcome after thrombolysis in acute ischemic stroke. J Korean Neurosurg Soc 50(2):75–80CrossRef

Demchuk AM, Khan F, Hill MD, Barber PA, Silver B, Patel S, Levine SR, NINDS rt-PA Stroke Study Group (2008) NINDS rt-PA stroke study group. Importance of leukoaraiosis on CT for tissue plasminogen activator decision making: evaluation of the NINDS rt-PA stroke study. Cerebrovasc Dis 26(2):120–125CrossRef

Palumbo V, Boulanger J, Hill M, Inzitari D, Buchan A, Investigators C (2007) Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke. Neurology. 68(13):1020–1024CrossRef

Howard G, Goff DC (2012) Population shifts and the future of stroke: forecasts of the future burden of stroke. Ann N Y Acad Sci 1268:14–20CrossRef

Tanne D, Gorman MJ, Bates VE et al (2000) Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older: the tPA stroke survey experience. Stroke 31(2):370–375CrossRef

Sawada H, Udaka F, Izumi Y, Nishinaka K, Kawakami H, Nakamura S, Kameyama M (2000) Cerebral white matter lesions are not associated with apoE genotype but with age and female sex in Alzheimer's disease. J Neurol Neurosurg Psychiatry 68(5):653–656CrossRef

10.

Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke (ECASS II). Lancet. 352(9136):1245–1251CrossRef

11.

Costello C, Campbell B, de la Ossa NP, Zheng T, Sherwin J, Weir L et al (2012) Age over 80years is not associated with increased hemorrhagic transformation after stroke thrombolysis. J Clin Neurosci 19(3):360–363CrossRef

12.

Hachinski VC, Potter P, Merskey H (1987) Leuko-araiosis. Arch Neurol 44(1):21–23CrossRef

13.

Debette S, Markus HS (2010) The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 341:c3666CrossRef

14.

Rost NS, Rahman RM, Biffi A, Smith EE, Kanakis A, Fitzpatrick K, Lima F, Worrall BB, Meschia JF, Brown RD, Brott TG, Sorensen AG, Greenberg SM, Furie KL, Rosand J (2010) White matter hyperintensity volume is increased in small vessel stroke subtypes. Neurology 75:1670–1677CrossRef

15.

Willer L, Havsteen I, Ovesen C, Christensen AF, Christensen H (2015) Computed tomography-verified Leukoaraiosis is a risk factor for post-thrombolytic hemorrhage. J Stroke Cerebrovasc Dis 24(6):1126–1130CrossRef

16.

Neumann-Haefelin T, Hoelig S, Berkefeld J, Fiehler J, Gass A, Humpich M, Kastrup A, Kucinski T, Lecei O, Liebeskind DS, Rother J, Rosso C, Samson Y, Saver JL, Yan B, MR Stroke Group (2006) Leukoaraiosis is a risk factor for symptomatic intracerebral hemorrhage after thrombolysis for acute stroke. Stroke 37(10):2463–2466CrossRef

17.

Curtze S, Haapaniemi E, Melkas S, Mustanoja S, Putaala J, Sairanen T, Sibolt G, Tiainen M, Tatlisumak T, Strbian D (2015) White matter lesions double the risk of post-thrombolytic Intracerebral hemorrhage. Stroke. 46(8):2149–2155CrossRef

18.

Kongbunkiat K, Wilson D, Kasemsap N, Tiamkao S, Jichi F, Palumbo V, Hill MD, Buchan AM, Jung S, Mattle HP, Henninger N, Werring DJ (2017) Leukoaraiosis, intracerebral hemorrhage and functional outcome after acute stroke thrombolysis. Neurology. 88(7):638–645CrossRef

19.

Engelter ST, Bonati LH, Lyrer PA (2006) Intravenous thrombolysis in stroke patients of > or = 80 versus < 80 years of age--a systematic review across cohort studies. Age Ageing 35(6):572–580CrossRef

20.

Yang CM, Hung CL, Su HC, Lin HJ, Chen CH, Lin CC, Hu HH, Lin SH, Sung PS (2018) Leukoaraiosis and risk of intracranial hemorrhage and outcome after stroke thrombolysis. PLoS One 13(5):e0196505CrossRef

21.

Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S (1999) Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS study: a randomized controlled trial. Alteplase thrombolysis for acute noninterventional therapy in ischemic stroke. JAMA. 282(21):2019–2026CrossRef

22.

Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F, PROACT Investigators (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. JAMA 282:2003–2011CrossRef

23.

Alshekhlee A, Mohammadi A, Mehta S, Edgell RC, Vora N, Feen E, Kale S, Shakir ZA, Cruz-Flores S (2010) Is thrombolysis safe in the elderly?: analysis of a national database. Stroke. 41(10):2259–2264CrossRef

24.

Mehta RH, Cox M, Smith EE, Xian Y, Bhatt DL, Fonarow GC, Peterson ED, Get With The Guidelines-Stroke Program (2014) Race/ethnic differences in the risk of hemorrhagic complications among patients with ischemic stroke receiving thrombolytic therapy. Stroke 45(8):2263–2269CrossRef

25.

Menon BK, Saver JL, Prabhakaran S, Reeves M, Liang L, Olson DWM, Peterson ED, Hernandez AF, Fonarow GC, Schwamm LH, Smith EE (2012) Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Stroke 43:2293–2299CrossRef

26.

Chen Y, Yan S, Xu M, Zhong G, Liebeskind DS, Lou M (2018) More extensive white matter hyperintensity is linked with higher risk of remote intracerebral hemorrhage after intravenous thrombolysis. Eur J Neurol 25(2):380–e15CrossRef

27.

Charidimou A, Pasi M, Fiorelli M, Shams S, von Kummer R, Pantoni L, Rost N (2016) Leukoaraiosis, cerebral hemorrhage, and outcome after intravenous thrombolysis for acute ischemic stroke: a meta-analysis (v1). Stroke. 47(9):2364–2372CrossRef

28.

Nighoghossian N, Abbas F, Cho TH, Geraldo AF, Cottaz V, Janecek E, Mechtouff L, Bischoff M, el Khoury C, Schott AM, Derex L, Hermier M, Tisserand LG, Amelie R, Chamard L, Berthezene Y (2016) Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis. Neuroradiology. 58(10):961–967CrossRef

29.

Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, Lindley RI, O'Brien JT, Barkhof F, Benavente OR, Black SE, Brayne C, Breteler M, Chabriat H, Decarli C, de Leeuw FE, Doubal F, Duering M, Fox NC, Greenberg S, Hachinski V, Kilimann I, Mok V, Oostenbrugge Rv, Pantoni L, Speck O, Stephan BC, Teipel S, Viswanathan A, Werring D, Chen C, Smith C, van Buchem M, Norrving B, Gorelick PB, Dichgans M, STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1) (2013) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 12(8):822–838CrossRef

30.

Birns J, Jarosz J, Markus HS, Kalra L (2009) Cerebrovascular reactivity and dynamic autoregulation in ischaemic subcortical white matter disease. J Neurol Neurosurg Psychiatry 80(10):1093–1098CrossRef

31.

Moody DM, Brown WR, Challa VR, Anderson RL (1995) Periventricular venous collagenosis: association with leukoaraiosis. Radiology 194(2):469–476CrossRef

32.

Fernandez-Cadenas I, Mendioroz M, Domingues-Montanari S, Del Rio-Espinola A, Delgado P, Ruiz A et al (2011) Leukoaraiosis is associated with genes regulating blood-brain barrier homeostasis in ischaemic stroke patients. Eur J Neurol 18(6):826–835CrossRef

33.

Huisa BN, Caprihan A, Thompson J, Prestopnik J, Qualls CR, Rosenberg GA (2015) Long-term blood-brain barrier permeability changes in Binswanger disease. Stroke. 46(9):2413–2418CrossRef

34.

Kahles T, Foerch C, Sitzer M, Schroeter M, Steinmetz H, Rami A (2005) el ta. Tissue plasminogen activator mediated blood-brain barrier damage in transient focal cerebral ischemia in rats: relevance of interactions between thrombotic material and thrombolytic agent. Vasc Pharmacol 43(4):254–259CrossRef

35.

Curtze S, Melkas S, Sibolt G, Haapaniemi E, Mustanoja S, Putaala J et al (2015) Cerebral computed tomography-graded white matter lesions are associated with worse outcome after thrombolysis in patients with stroke. Stroke. 46(6):1554–1560CrossRef

36.

Nordahl CW, Ranganath C, Yonelinas AP, Decarli C, Fletcher E, Jagust WJ (2006) White matter changes compromise prefrontal cortex function in healthy elderly individuals. J Cogn Neurosci 18:418–429CrossRef

Title: The relationship of leukoaraiosis, haemorrhagic transformation and prognosis at 3 months after intravenous thrombolysis in elderly patients aged ≥ 60 years with acute cerebral infarction
Authors: Xiaowei Liu
Jiatang Zhang
Chenglin Tian
Jun Wang
Publication date: 01-11-2020
Publisher: Springer International Publishing
Keyword: Stroke
Published in: Neurological Sciences / Issue 11/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04398-2

At a glance: The STEP trials

Springer Medicine

The relationship of leukoaraiosis, haemorrhagic transformation and prognosis at 3 months after intravenous thrombolysis in elderly patients aged ≥ 60 years with acute cerebral infarction

Abstract

Backgroud

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Backgroud

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2020

Guillain-Barre syndrome during COVID-19 pandemic: an overview of the reports

Behavior in subcortical vascular dementia with sight pathologies: visual hallucinations as a consequence of precocious gait imbalance and institutionalization

The quality of measurement properties of neurocognitive assessment in brain tumor clinical trials over the last 30 years: a COSMIN checklist-based approach

The association between the adrenergic hyperactivity and blood pressure values in people with multiple sclerosis

Tarlov’s cyst as an underestimated cause of persistent genital arousal disorder: a case report and review

Features in essential tremor and the development of Parkinson’s disease vs. parkinsonism