title: White matter lesions and intra-arterial thrombolysis.
abstract: The aim of the study was to assess the influence of white matter lesions in patients with acute ischemic stroke treated with intra-arterial thrombolysis (IAT). From September 2003 to January 2010, we treated 400 patients with IAT at our institution. Of these patients, 292 were evaluated with MRI scans and included in this observational study. Clinical data were collected prospectively. Outcome after 3 months was measured with the modified Rankin Scale (mRS); mRS 0-1 was considered as favorable outcome. White matter lesions were scored visually by two observers using the semiquantitative Scheltens and Fazekas scores. Logistic regression analysis was used to identify the association of white matter lesions and clinical outcome, recanalization, and cerebral hemorrhage. The severity of white matter lesions was inversely correlated with favorable outcome, survival and successful recanalization. White matter lesions were an independent predictor of outcome (OR 0.569, p = 0.007) and survival (OR 0.550, p = 0.018) and a weak but independent predictor for recanalization (OR 0.949, p = 0.038). Asymptomatic intracerebral bleeding after IAT was associated with white matter lesions in the basal ganglia in the univariate analysis (p = 0.036), but not after multivariable analysis. The severity of white matter lesions independently predicts clinical outcome and survival in patients treated with IAT. White matter lesions are also a weak but independent predictor for recanalization. Symptomatic intracranial bleeding after IAT are not associated with white matter lesions. Therefore, white matter lesions should not be considered as a contraindication against IAT.
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.forename: Marie Luise
authors.initials: ML
authors.lastname: Mono
authors.forename: Oliver
authors.initials: O
authors.lastname: Findling
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Aekaterini
authors.initials: A
authors.lastname: Galimanis
authors.forename: Anja
authors.initials: A
authors.lastname: Weck
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: De Marchis
authors.forename: Pietro
authors.initials: P
authors.lastname: Ballinari
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.forename: Caspar
authors.initials: C
authors.lastname: Brekenfeld
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007269:Injections, Intra-Arterial; D056784:Leukoencephalopathies / Q000150:complications* / Q000188:drug therapy*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome