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Small vessel disease and clinical outcomes after IV rt-PA treatment
- Source :
- Arba, F, Inzitari, D, Ali, M, Warach, S J, Luby, M, Lees, K R, Albers, G W, Davis, S M, Donnan, G A, Fisher, M, Furlan, A J, Grotta, J C, Hacke, W, Kang, D W, Kidwell, C, Koroshetz, W J, Lev, M H, Liebeskind, D S, Gregory Sorensen, A, Thijs, V N, Thomalla, G, Wardlaw, J M & Wintermark, M 2017, ' Small vessel disease and clinical outcomes after IV rt-PA treatment ', Acta Neurologica Scandinavica, vol. 136, no. 1, pp. 72-77 . https://doi.org/10.1111/ane.12745
- Publication Year :
- 2017
-
Abstract
- Introduction:\ud \ud 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.\ud Methods:\ud \ud 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.\ud Results:\ud \ud 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.\ud Conclusion:\ud \ud 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.
- Subjects :
- Male
medicine.medical_specialty
Pathology
small vessel disease
medicine.medical_treatment
Clinical Neurology
030204 cardiovascular system & hematology
Logistic regression
Ordinal regression
magnetic resonance
03 medical and health sciences
0302 clinical medicine
Modified Rankin Scale
Internal medicine
medicine
Dementia
Humans
intravenous thrombolysis
Stroke
Aged
Aged, 80 and over
medicine.diagnostic_test
business.industry
Confounding
Magnetic resonance imaging
General Medicine
Thrombolysis
white matter changes
Middle Aged
medicine.disease
stroke
Magnetic Resonance Imaging
clinical outcomes
Neurology
Cerebral Small Vessel Diseases
Tissue Plasminogen Activator
Cardiology
Female
Neurology (clinical)
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 16000404 and 00016314
- Volume :
- 136
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Acta neurologica Scandinavica
- Accession number :
- edsair.doi.dedup.....92cde66bb4d983faac8e27025839f46e