Relationship between total cerebral small vessel disease burden and hemorrhagic transformation of acute ischemic stroke patients after intravenous thrombolysis

Abstract

Objective To investigate the relationship between total cerebral small vessel disease (CSVD) burden and intracranial hemorrhage transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods One hundred and fifty-four patients who suffered from ischemic stroke within 4.5 hours of onset and received recombinant tissue plasminogen activator thrombolytic therapy in the emergency green channel of the First Affiliated Hospital of Soochow University from August 2016 to January 2018 were enrolled. HT examined by computed tomography scan within 24 hours after thrombolysis was included. The magnetic resonance imaging examination was performed within 48 hours. The patients were divided into two groups: HT group and control group according to the presence or absence of HT. Periventricular white-matter hyperintensities (WMH) with Fazekas score of 3 or deep WMH with Fazekas score of 2 or 3 was recorded as 1 point, MRI of cerebral microbleeds (CMBs) or lacunar infarction (LI) was recorded as 1 point respectively, and peripheral vascular space (PVS) in basal ganglia graded 2-4 (≥11) was counted 1 point. Single-factor analysis was used to compare total CSVD burden score, baseline data and clinical data between the two groups. Multivariate Logistic regression analysis was performed to explore the relationship between total CSVD burden score and HT. Results The age of the 154 patients was 66.00 (59.00,74.25) years, males accounted for 66.9% (103/154), onset to treatment time (OTT) was 174.50 (131.50, 200.00) minutes and the NIHSS score before thrombolytic therapy was 6.00 (3.00, 10.25). There were 43 cases (27.9%) with moderate to severe WMH, 35 cases (22.7%) with CMBs, 52 cases (33.8%) with PVS graded 2-4, and 96 cases (62.3%) with LI. There were 21 enrolled patients (13.6%) who suffered from HT. Symptomatic intracranial hemorrhage occurred in nine cases (5.8%). In the multivariate Logistic regression model, the results demonstrated that baseline diastolic pressure (OR=1.072, 95%CI 1.027-1.118, P=0.001) and atrial fibrillation (OR=28.564, 95%CI 6.217-131.241, P=0.000) were independently associated with HT. After using the mild CSVD burden score as a reference, moderate CSVD burden (OR=0.810, 95% CI 0.154-4.257, P=0.804) was not associated with HT after thrombolysis, and severe CSVD burden (OR=8.429, 95% CI 1.643-43.227, P=0.011) was independently associated with HT. Conclusions The severity of total CSVD burden in patients with AIS was closely related to HT after thrombolysis. Severe CSVD was an independent risk factor for HT after thrombolysis. Key words: Stroke; Intravenous thrombolysis; Cerebral small vessel disease; Hemorrhagic transformation