Effect Of White Matter Hyperintensities And Cerebral Microbleeds On Intravenous Thrombolvsis In Acute Ischemic Stroke

Objective:To investigate the relationship between white matter hyperintensities (WMHs) and cerebral microbleeds (CMBs) and hemorrhagic transformation (HT) and neurological outcome at3months after recombinant tissue plasminogen activator (rt-PA) treatment in patients with acute ischemic stroke.Methods:Prospective clinical, laboratory, and radiological data from patients with acute ischemic stroke who had received intravenous rt-PA therapy in our hospital were retrospectively reviewed. The severity of WMHs according to the modified Scheltens scale was assessed. Number of CMBs were calculated on the scans of Susceptibility Weighted Imaging (SWI). HT and clinical neurological outcome based on modified Rankin scale (mRS) at3months were also analyzed. Favorable outcome as mRS0-1and unfavorable outcome as mRS2-6were defined. Results:144patients receiving intravenous rt-PA treatment in this study were finally enrolled. The mean age was (66.56±12.57) years old,46(31.9%) were women, pretreatment National Institutes of Health Stroke Scale score (NIHSS) was12.31±5.98, door-to-needle time was (241.88±88.39) minutes, and WMHs score was7.81±4.93. Postlytic radiological HT was found in28patients (19.4%). Hemorrhagic infarction (HI) was found in18(12.5%) patients while parenchymal hematoma (PH) was found in10(6.9%) patients.280CMBs were found in26among126patients who received SWI scans. Logistic regression analysis showed that severity of WMHs was not associated with HT (HI and PH)(OR=1.017,95%CI0.919-1.126, P=0.744vs OR=1.025,95%CI0.895-1.175, P=0.716, respectively), but independently associated with unfavorable outcome (OR=1.135,95%CI1.036-1.244, P=0.007).Number of CMBs are neither associated with HT (OR=0.999,95%CI0.870-1.146, P=0.987vs OR=1.015,95%CI0.891～1.155, P=0.826, respectively) nor unfavorable neurological outcome (OR=0.986,95%CI0.934-1.040, P=0.596)。Conclusion:Severe WMHs are not associated with HT but independently associated with unfavorable neurological outcome after thrombolytic therapy in patients with acute ischemic stroke. Number of CMBs are neither associated with HT nor unfavorable neurological outcome.