Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients
BackgroundHemorrhagic transformation (HT) is common among acute ischemic stroke patients after treatment with intravenous thrombolysis (IVT). We analyzed potential relationships between markers of cerebral small vessel disease (CSVD) and HT in patients after IVT.MethodsThis study retrospectively ana...
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1144564/full |
| _version_ | 1797854124189941760 |
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| author | Zhenxiang Zhan Zhenxiang Zhan Tong Xu Ye Xu Fangwang Fu Zicheng Cheng Lingfan Xia Yucong Wu Xuan Xu Yungang Cao Zhao Han |
| author_facet | Zhenxiang Zhan Zhenxiang Zhan Tong Xu Ye Xu Fangwang Fu Zicheng Cheng Lingfan Xia Yucong Wu Xuan Xu Yungang Cao Zhao Han |
| author_sort | Zhenxiang Zhan |
| collection | DOAJ |
| description | BackgroundHemorrhagic transformation (HT) is common among acute ischemic stroke patients after treatment with intravenous thrombolysis (IVT). We analyzed potential relationships between markers of cerebral small vessel disease (CSVD) and HT in patients after IVT.MethodsThis study retrospectively analyzed computed tomography (CT) data for acute ischemic stroke patients before and after treatment with recombinant tissue plasminogen activator at a large Chinese hospital between July 2014 and June 2021. Total CSVD score were summed by individual CSVD markers including leukoaraiosis, brain atrophy and lacune. Binary regression analysis was used to explore whether CSVD markers were related to HT as the primary outcome or to symptomatic intracranial hemorrhage (sICH) as a secondary outcome.ResultsA total of 397 AIS patients treated with IVT were screened for inclusion in this study. Patients with missing laboratory data (n = 37) and patients treated with endovascular therapy (n = 42) were excluded. Of the 318 patients included, 54 (17.0%) developed HT within 24–36 h of IVT, and 14 (4.3%) developed sICH. HT risk was independently associated with severe brain atrophy (OR 3.14, 95%CI 1.43–6.92, P = 0.004) and severe leukoaraiosis (OR 2.41, 95%CI 1.05–5.50, P = 0.036), but not to severe lacune level (OR 0.58, 95%CI 0.23–1.45, P = 0.250). Patients with a total CSVD burden ≥1 were at higher risk of HT (OR 2.87, 95%CI 1.38–5.94, P = 0.005). However, occurrence of sICH was not predicted by CSVD markers or total CSVD burden.ConclusionIn patients with acute ischemic stroke, severe leukoaraiosis, brain atrophy and total CSVD burden may be risk factors for HT after IVT. These findings may help improve efforts to mitigate or even prevent HT in vulnerable patients. |
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| language | English |
| last_indexed | 2024-04-09T20:00:45Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
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| spelling | doaj.art-503616ac3c774be6a43454fe23673f992023-04-03T04:35:45ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-04-011410.3389/fneur.2023.11445641144564Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patientsZhenxiang Zhan0Zhenxiang Zhan1Tong Xu2Ye Xu3Fangwang Fu4Zicheng Cheng5Lingfan Xia6Yucong Wu7Xuan Xu8Yungang Cao9Zhao Han10Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, ChinaDepartment of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, ChinaDepartment of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaBackgroundHemorrhagic transformation (HT) is common among acute ischemic stroke patients after treatment with intravenous thrombolysis (IVT). We analyzed potential relationships between markers of cerebral small vessel disease (CSVD) and HT in patients after IVT.MethodsThis study retrospectively analyzed computed tomography (CT) data for acute ischemic stroke patients before and after treatment with recombinant tissue plasminogen activator at a large Chinese hospital between July 2014 and June 2021. Total CSVD score were summed by individual CSVD markers including leukoaraiosis, brain atrophy and lacune. Binary regression analysis was used to explore whether CSVD markers were related to HT as the primary outcome or to symptomatic intracranial hemorrhage (sICH) as a secondary outcome.ResultsA total of 397 AIS patients treated with IVT were screened for inclusion in this study. Patients with missing laboratory data (n = 37) and patients treated with endovascular therapy (n = 42) were excluded. Of the 318 patients included, 54 (17.0%) developed HT within 24–36 h of IVT, and 14 (4.3%) developed sICH. HT risk was independently associated with severe brain atrophy (OR 3.14, 95%CI 1.43–6.92, P = 0.004) and severe leukoaraiosis (OR 2.41, 95%CI 1.05–5.50, P = 0.036), but not to severe lacune level (OR 0.58, 95%CI 0.23–1.45, P = 0.250). Patients with a total CSVD burden ≥1 were at higher risk of HT (OR 2.87, 95%CI 1.38–5.94, P = 0.005). However, occurrence of sICH was not predicted by CSVD markers or total CSVD burden.ConclusionIn patients with acute ischemic stroke, severe leukoaraiosis, brain atrophy and total CSVD burden may be risk factors for HT after IVT. These findings may help improve efforts to mitigate or even prevent HT in vulnerable patients.https://www.frontiersin.org/articles/10.3389/fneur.2023.1144564/fullacute ischemic strokeintravenous thrombolysishemorrhagic transformationbrain atrophycerebral small vessel diseaseleukoaraiosis |
| spellingShingle | Zhenxiang Zhan Zhenxiang Zhan Tong Xu Ye Xu Fangwang Fu Zicheng Cheng Lingfan Xia Yucong Wu Xuan Xu Yungang Cao Zhao Han Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients Frontiers in Neurology acute ischemic stroke intravenous thrombolysis hemorrhagic transformation brain atrophy cerebral small vessel disease leukoaraiosis |
| title | Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients |
| title_full | Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients |
| title_fullStr | Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients |
| title_full_unstemmed | Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients |
| title_short | Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients |
| title_sort | associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients |
| topic | acute ischemic stroke intravenous thrombolysis hemorrhagic transformation brain atrophy cerebral small vessel disease leukoaraiosis |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1144564/full |
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