tPA treatment for acute ischaemic stroke in patients with leukoaraiosis.
OBJECTIVE
Whether leukoaraiosis on baseline CT is associated with an increased risk of symptomatic intracerebral haemorrhage (sICH) or poor outcome following tissue plasminogen activator (tPA) treatment for acute ischaemic stroke is still a matter of debate.


OBJECTIVE
To investigate the relationship between the presence and severity of leukoaraiosis on baseline CT and the risk of sICH and functional outcome after tPA treatment for acute ischaemic stroke.


METHODS
A single-center observational cohort study with a retrospective analysis on consecutive patients with ischaemic stroke treated with tPA in the period 2002-2008. Outcome measures were the occurrence of sICH and functional outcome at 3 months.


RESULTS
Of the 400 patients, 24% had leukoaraiosis on their baseline CT. Eleven patients (11%) with leukoaraiosis versus thirteen (4%) patients without leukoaraiosis had a sICH [odds ratio (OR) 2.85 95%-CI 1.23-6.60, P = 0.02]. Multivariate analysis showed a non-significant trend towards an association of leukoaraiosis and sICH (OR 1.9, 95%-CI 0.78-4.68, P = 0.16). Leukoaraiosis was independently associated with poor functional outcome (OR 2.39, 95%-CI 1.21-4.72, P = 0.01). No difference was observed in the outcome measures amongst patients with moderate or severe leukoaraiosis.


CONCLUSIONS
Our study demonstrates that patients treated with tPA and leukoaraiosis on their baseline CT are at greater risk of sICH and have a worse functional outcome compared to patients without leukoaraiosis. It is important to note that these results should not lead to exclusion of patients with leukoaraiosis for tPA treatment.
Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands. m.j.h.aries@neuro.umcg.nl
M J H
MJ
Ariës
M
M
Uyttenboogaart
P C
PC
Vroomen
J
J
De Keyser
G J
GJ
Luijckx
D000368:Aged; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D049292:Leukoaraiosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications* / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator