title: Leukoaraiosis and lacunes are associated with poor clinical outcomes in ischemic stroke patients treated with intravenous thrombolysis.
abstract: BACKGROUND
  The effect of preexisting small vessel disease on outcomes of patients with ischemic stroke treated with i.v. thrombolysis is not fully understood.
  
  
  OBJECTIVE
  We aim to investigate the effect of combined leukoaraiosis and lacunes as detected on unenhanced brain computer tomography at baseline on clinical outcomes after i.v. thrombolysis.
  
  
  METHODS
  We analyzed data from the Canadian Alteplase for Stroke Effectiveness Study. Small vessel disease was assessed on baseline computer tomography rating for leukoaraiosis and lacunes. We dichotomized the burden of small vessel disease to "absent or moderate" and "severe." Clinical outcomes at 90 days included excellent outcome (mRS = 0-1), good outcome (mRS = 0-2), and the occurrence of symptomatic intracerebral hemorrhage. Sensitivity analysis was performed on two age groups (≤80 versus >80). We ran logistic regression adjusting for confounders to evaluate independent effect of small vessel disease on outcomes.
  
  
  RESULTS
  There were 820 patients with available brain computer tomography with mean age (±SD) of 71.3 (±13.2), 455 (55.5%) were male. Of these, 123 (15%) patients had severe small vessel disease at baseline. Age group analysis revealed significant associations of small vessel disease only in patients aged ≤80. After adjustment for confounders, presence of severe small vessel disease reduced the chances of both excellent (OR = 0.42, 95% CI = 0.24-0.74) and good outcome (OR = 0.35, 95% CI = 0.21-0.58) and with an increased risk of symptomatic intracerebral hemorrhage (OR = 5.91; 95% CI = 2.40-14.57).
  
  
  CONCLUSIONS
  When considered together as radiological expressions of small vessel disease, presence and severity of severe leukoaraiosis and lacunes on baseline computer tomography scan are associated with poor clinical outcomes in patients treated with i.v. thrombolysis.
authors.affiliation: NEUROFARBA Department, University of Florence, Florence, Italy francesco.arba@unifi.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Arba
authors.affiliation: Stroke Unit and Neurology, Careggi Hospital, Florence, Italy.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Palumbo
authors.affiliation: Department of Medical Imaging, University of Toronto, Toronto, Canada.
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Boulanger
authors.affiliation: NEUROFARBA Department, University of Florence, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pracucci
authors.affiliation: NEUROFARBA Department, University of Florence, Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
authors.affiliation: Acute Stroke Program, Department of Medicine and Clinical Geratology, University of Oxford, Oxford, UK.
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Buchan
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002170:Canada; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D049292:Leukoaraiosis / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke; lacunes; leukoaraiosis; small vessel disease; thrombolysis