Abstract

Objective To investigate the relationship between white-matter hyperintensities (WMHs) and hemorrhagic transformation (HT) and neurological outcome at 3 months after recombinant tissue plasminogen activator (rt-PA) treatment in patients with acute ischemic stroke. Methods Prospective clinical，laboratory，and radiological data from patients with acute ischemic stroke who had received intravenous rt-PA therapy in our hospital were retrospectively reviewed.The severity of WM Hs according to the modified Scheltens scale was assessed.Hemorrhagic transformation after thrombolytic therapy and clinical neurological outcome based on modified Rankin scale (mRS) at 3 months were also analyzed.Favorable outcome as mRS 0-1 and unfavorable outcome as mRS 2-6 were defined. Results One hundred and forty-four patients receiving intravenous rt-PA treatment in this study were finally enrolled.The mean age was (66.6±12.6) years old，46 (31.9%) were women，pretreatment National Institutes of Health Stroke Scale score was 12.31±5.98，door-to-needle time was (241.9±88.4) minutes，and WMHs score was 7.81±4.93.Postlytic radiological HT was found in 28 patients (19.4%).Hemorrhagic infarction (HI) was found in 18 (12.5%) patients while parenchymal hematoma (PH) was found in 10 (6.9%) patients.Logistic regression analysis showed that severity of WM Hs was not associated with hemorrhagic transformation (HI and PH，OR=1.017，95% CI 0.919-1.126，P=0.744; OR=1.025，95% CI 0.895-1.175，P=0.716，respectively)，but independently associated with unfavorable outcome (OR=1.135，95% CI 1.036-1.244，P=0.007). Conclusions Severe WMHs are not associated with hemorrhagic transformation but independently associated with unfavorable neurological outcome after thrombolytic therapy in patients with acute ischemic stroke. Key words: Brain ischemia; Stroke; Leukoaraiosis; Thrombolytic therapy; Tissue plasminogen activator; Magnetic resonance imaging

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