title: Small vessel disease and clinical outcomes after IV rt-PA treatment.
abstract: BACKGROUND
  Cerebral small vessel disease (SVD) contributes to dementia and disability in the elderly, and may negatively affect stroke outcomes. We aimed to evaluate to what extent single features and global burden of SVD detected with magnetic resonance (MR) are associated with worse outcomes in patients with ischaemic stroke treated with intravenous thrombolysis.
  
  
  METHODS
  We accessed anonymized data and MR images from the Stroke Imaging Repository (STIR) and the Virtual International Stroke Trials Archive (VISTA) Imaging. We described SVD features using validated scales and quantified the global burden of SVD with a combined score. Our mainoutcome was the modified Rankin Scale (mRS) at 90 days after stroke. We used logistic regression and ordinal regression models (adjusted for age, sex, stroke severity, onset to treatment time) to examine the associations between each SVD feature, SVD global burden and clinical outcomes.
  
  
  RESULTS
  A total of 259 patients had MR scans available at baseline (mean age±SD=68.7±15.5 years; 131 [49%] males). After adjustment for confounders, severe white matter changes were associated with disability (OR=5.14; 95%CI=2.30-11.48), functional dependency (OR=4.38; 95%CI=2.10-9.13) and worse outcomes in ordinal analysis (OR=2.71; 95%CI=1.25-5.85). SVD score was associated with disability (OR=1.66; 95%CI=1.03-2.66) and functional dependency (OR=1.47; 95%CI=1.00-2.45). Lacunes, enlarged perivascular spaces and brain atrophy showed no association with clinical outcomes.
  
  
  CONCLUSIONS
  Our results suggest that SVD negatively affects stroke outcomes after intravenous thrombolysis. Although white matter changes seem to be the major driver in relation to worse outcomes, global estimation of SVD is feasible and may provide helpful information.
authors.affiliation: NEUROFARBA Department, University of Florence, Florence, Italy.|Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK.
authors.forename: F
authors.identifier: http://orcid.org/0000-0003-3941-7383
authors.initials: F
authors.lastname: Arba
authors.affiliation: NEUROFARBA Department, University of Florence, Florence, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Inzitari
authors.affiliation: Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ali
authors.affiliation: Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Warach
authors.affiliation: National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Luby
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Lees
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059345:Cerebral Small Vessel Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D010959:Tissue Plasminogen Activator
keywords: clinical outcomes; intravenous thrombolysis; magnetic resonance; small vessel disease; stroke; white matter changes