Acute Anterior Circulation Stroke Patients Research Articles

Risk score for symptomatic intracranial haemorrhage in patients with acute ischaemic stroke receiving endovascular treatment

Background and purposeThis study aimed to develop a score to predict the risk for symptomatic intracranial haemorrhage (sICH) associated with endovascular treatment (EVT) in patients with acute ischaemic stroke caused by large vessel occlusions (LVOs) in the anterior circulation. MethodsBetween January 2017 and December 2019, acute stroke patients with anterior circulation occlusion and EVT were retrospectively enroled from 11 comprehensive stroke centres in China. Univariate analyses were performed to compare the factors in patients with or without sICH. The predictive value of parameters associated with sICH was evaluated with multivariate logistic regression, and the score was developed according to the magnitude of regression coefficients. We performed external validation in a retrospective stroke registry of EVT for acute anterior circulation ischaemic stroke in 21 comprehensive stroke centres across 10 provinces in China (ACTUAL). ResultsOf the 433 patients, 70 (16.2%) patients had sICH. The preoperative predictive factors of sICH were poor collateral circulation, low baseline ASPECTS, cardioembolic stroke and high serum glucose. Using the OR of preoperative predictive factors (collateral circulation status, baseline ASPECTS, TOAST type and serum glucose) in the multivariable model, we derived the ACTS score. In the derivation cohort, the area under the ROC curve (AUC) was 0.797; in the validation cohort, it was 0.727. ConclusionThe ACTS score provides a quick and easy-to-perform scale to predict the risk of sICH in acute anterior circulation stroke patients treated with EVT. This score should be further examined and improved in future prospective studies to increase its precision and applicability before it can be recommended to make clinical decisions regarding the performance of EVT.

Red Cell Distribution Width as a Predictor of One-Year Prognosis and Mortality of Endovascular Therapy for Acute Anterior Circulation Ischemic Stroke

ObjectivesTo investigate if Red cell distribution width (RDW) can predict long-term prognosis in patients with acute ischemic stroke (AIS) receiving endovascular therapy (EVT). MethodsIn this study, 102 AIS patients treated with EVT were retrospectively recruited. Clinical profiles and prognoses were collected for all patients. The patients were grouped following the modified ranking scale (MRS) scoring system as given below: a group of favorable functional outcome: 0–2; and a group of unfavorable functional outcome: 3–6. ResultsIn multivariate logistic regression, RDW (odds ratio [OR] = 2.799, 95 % confidence interval [CI] = 1.425–5.489; p = 0.003) was an independent predictor of unfavorable functional outcome, and it (OR, 1.929; 95% CI, 1.075–3.458; p = 0.028) was also an independent biomarker for all-cause mortality. The best predictive RDW cut-off value was 13.05% (sensitivity: 93.1%, specificity: 60.3%, AUC: 0.806, p < 0.001). ConclusionsThe results imply that pre-RDW is a reliable predictor of one-year prognosis and mortality after EVT in acute anterior circulation stroke patients.

Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume

BackgroundThe presence of metabolically viable brain tissue that may be salvageable with rapid cerebral blood flow restoration is the fundament rationale for reperfusion therapy in patients with large vessel occlusion stroke. The effect of endovascular treatment (EVT) on functional outcome largely depends on the degree of recanalization. However, the relationship of recanalization degree and penumbra salvage has not yet been investigated. We hypothesized that penumbra salvage volume mediates the effect of thrombectomy on functional outcome.Methods99 acute anterior circulation stroke patients who received multimodal CT and underwent thrombectomy with resulting partial to complete reperfusion (modified thrombolysis in cerebral infarction scale (mTICI) ≥ 2a) were retrospectively analyzed. Penumbra volume was quantified on CT perfusion and penumbra salvage volume (PSV) was calculated as difference of penumbra and net infarct growth from admission to follow-up imaging.ResultsIn patients with complete reperfusion (mTICI ≥ 2c), the median PSV was significantly higher than the median PSV in patients with partial or incomplete (mTICI 2a–2b) reperfusion (median 224 mL, IQR: 168–303 versus 158 mL, IQR: 129–225; p < 0.01). A higher degree of recanalization was associated with increased PSV (+ 63 mL per grade, 95% CI: 17–110; p < 0.01). Higher PSV was also associated with improved functional outcome (OR/mRS shift: 0.89; 95% CI: 0.85–0.95, p < 0.0001).ConclusionsPSV may be an important mediator between functional outcome and recanalization degree in EVT patients and could serve as a more accurate instrument to compare treatment effects than infarct volumes.

Treatment Approaches and Outcomes for Acute Anterior Circulation Stroke Patients with Tandem Lesions

ObjectivesEndovascular thrombectomy (EVT) has revolutionized stroke care for large vessel occlusions (LVOs). However, over half treated remain functionally disabled or die. Patients with tandem lesions, or severe stenosis/occlusion of the cervical internal carotid artery (ICA) with intracranial LVO, may have technical EVT challenges and worse outcomes. We sought to compare treatments and outcomes for patients with anterior circulation tandem lesions versus isolated LVOs. Materials and MethodsConsecutive tandem lesion and isolated intracranial LVO patients were identified at a single center. Demographics, medical history, presentations, treatments, and outcomes were collected and analyzed. ResultsFrom 381 EVT patients, 62 had tandem lesions related to atherosclerosis (74%) or dissection (26%). Compared to isolated intracranial LVOs, they were younger (63 vs 70, p = 0.003), had less atrial fibrillation (13% vs 40%, p < 0.0001), less adequate reperfusion (TICI 2b-3, 58% vs 82%, p < 0.0001), more intracranial hemorrhage (ICH, 13% vs 5%, p = 0.037), but similar 90-day functional independence (mRS 0–2, 34% vs 43%, p = 0.181). The cervical ICA was treated before intracranial EVT (57%), after (13%), not acutely (22%), or was inaccessible (8%). Acute cervical ICA treatments were stenting (57%) or angioplasty alone (13%). Neither acute stenting nor order of treatment was associated with outcomes (TICI 2b-3, ICH, or 90-day mRS 0-2). Among acutely stented, neither alteplase nor antiplatelets were associated with outcomes or stent patency. ConclusionsTandem lesions were associated with less reperfusion, more ICH, but similar 90-day functional independence. No treatment approach was associated with outcomes. These data illustrate the technical challenges of tandem lesion treatment and underscore the importance of developing new approaches.

The Therapeutic Effects of Endovascular Therapy with mTICI2b and 3 Recanalization for Acute Anterior Circulation Stroke Patients

Background and PurposeModified Thrombolysis in Cerebral Infarction (mTICI)2b/3 has been considered the criterion for successful reperfusion in endovascular treatment. This study aimed to compare the therapeutic safety and efficacy of mTICI2b and mTICI3 recanalization, and to analyze the factors related to outcomes in everyday clinical practice. Materials and MethodsThis is a single-center retrospective analysis of 224 patients who underwent successful thrombectomy (achieving a mTICI score ≥2b). The primary outcomes included a modified Rankin score (mRS) of 0-2 at 90-day, mortality, and symptomatic intracranial hemorrhage. ResultsA total of 111 patients achieved mTICI2b status (49.6%), and 113 achieved mTICI3 status (50.4%). The comparison between mTICI2b and 3 reperfusions showed no differences in short-term outcomes, 90-day mRS, complications, and mortality. There was a trend toward more passes in mTICI2b patients, although the difference was not significant. The univariate analysis showed that poor outcomes after endovascular treatment were associated with older age, previous history of coronary heart disease, atrial fibrillation, diabetes, tandem occlusions, high National Institutes of Health Stroke Scale (NIHSS) score on admission, and general anesthesia. A previous history of coronary heart disease, a high NIHSS score on admission, and the use of general anesthesia were independent factors that affected the therapeutic effects. ConclusionThe superiority (efficacy and safety) of mTICI3 reperfusion was not significant compared with that of mTICI2b reperfusion. Prolonged efforts to achieve mTICI3 after achieving mTICI2b should be considered prudently for those with difficulty achieving 100% reperfusion.

Predictors of a Favorable Outcome after Emergent Carotid Artery Stenting in Acute Anterior Circulation Stroke Patients.

PurposeThis study aimed to identify independent predictors of favorable outcomes associated with emergent carotid artery stenting (CAS) in patients with acute anterior circulation stroke.Materials and MethodsThis study included 93 patients with acute stroke who underwent emergent CAS to treat stenoocclusive lesions in the cervical internal carotid artery (ICA) within 6 hours of the onset of the associated symptoms. Data were compared between patients with and without favorable outcomes. The independent predictors of a favorable outcome were determined via logistic regression analysis (modified Rankin Scale 0–2 at 90 days).ResultsIntracranial tandem occlusion was noted in 81.7% of patients (76/93) among which (76/93), 55 of whom underwent intracranial recanalization therapy. Intracranial reperfusion was successful in 74.2% (69/93) and favorable outcomes were noted in 51.6% of patients (48/93). The mortality rate was 6.5% (6/93). In logistic regression analysis, diffusion-weighted imaging-Alberta Stroke Program Early CT Score [odds ratio (OR), 1.487; 95% confidence interval (CI), 1.018–2.173, p = 0.04], successful reperfusion (OR, 5.199; 95% CI, 1.566–17.265, p = 0.007), and parenchymal hemorrhage (OR, 0.042; 95% CI, 0.003–0.522, p = 0.014) were independently associated with a favorable outcome.ConclusionBaseline infarct size, reperfusion status, and parenchymal hemorrhage were independent predictors of favorable outcomes after emergent CAS to treat stenoocclusive lesions in the cervical ICA in patients with acute anterior circulation stroke.

Predictive value of G-FAST score for acute anterior circulation stroke patients with large artery occlusion

Objective: To investigate the accuracy of Gaze-face-arm-speech-time (G-FAST) score in the early diagnosis of acute anterior circulation stroke patients with large artery occlusion. Methods: A retrospective study was conducted to investigate the anterior circulation infarction (ACI) cases with complete vascular imaging data within 6 hours of onset in the Department of Neurology of Beijing Shijitan Hospital, Capital Medical University from May 2010 to April 2018. According to the results of digital subtraction angiography (DSA) or computed tomography angiography (CTA), the patients were divided into two groups: large artery occlusion group and non-large artery occlusion group. Accuracy of G-FAST score in predicting acute large artery occlusive stroke was analyzed by area under receiver operating characteristic curve (AUC). The predictive value of G-FAST score, National Institutes of Health Stroke Scale (NIHSS) score and Alberta stroke early CT score (ASPECTS) in predicting large artery occlusion was compared. Results: A total of 138 patients with acute anterior circulation ischemic stroke were included in the study, and 82 of them had large artery occlusion (59.4%). Univariate analysis showed that baseline NIHSS score (12.0 vs 8.9, P=0.000) and G-FAST score (3.1 vs 2.2, P=0.000) were significantly higher in patients with large artery occlusion than those without large artery occlusion, and ASPECTS was significantly lower than patients without large artery occlusion (7.4 vs 8.2, P=0.001). The results from ROC showed that G-FAST, NIHSS and ASPECTS were with the AUC of 0.781, 0.733 and 0.664, respectively. G-FAST score had the highest accuracy in predicting the anterior circulation arterial occlusion. The optimal threshold of G-FAST score was 2.5, with a sensitivity of 79.3% and a specificity of 64.3%. Further univariate analysis showed that percentage of large anterior vessel occlusion (LAVO) in G-FAST (≥3) group was significantly different from that in G-FAST (≤ 2) group [76.5%(65/85)∶32.1%(17/53), P=0.000]. Conclusions: G-FAST score has predictive value for acute anterior circulation arterial occlusive stroke. Endovascular treatment may need to consider in patients with high G-FAST score as early as possible when conditions permit.

Exploring Reperfusion Following Endovascular Thrombectomy.

Background and Purpose- Cerebral perfusion in acute ischemic stroke patients is often assessed before endovascular thrombectomy (EVT), but rarely after. Perfusion data obtained following EVT may provide additional prognostic information. We developed a tool to quantitatively derive perfusion measurements from digital subtraction angiography (DSA) data and examined perfusion in patients following EVT. Methods- Source DSA images from acute anterior circulation stroke patients undergoing EVT were retrospectively assessed. Following deconvolution, maps of mean transit time (MTT) were generated from post-EVT DSA source data. Thrombolysis in Cerebral Infarction grades and MTT in patients with and without hemorrhagic transformation (HT) at 24 hours were compared. Receiver operating characteristic modeling was used to classify the presence/absence of HT at 24 hours by MTT. Results- Perfusion maps were generated in 50 patients using DSA acquisitions that were a median (interquartile range) of 9 (8-10) seconds in duration. The median post-EVT MTT within the affected territory was 2.6 (2.2-3.3) seconds. HT was observed on follow-up computed tomography in 16 (32%) patients. Thrombolysis in Cerebral Infarction grades did not differ in patients with HT from those without (P=0.575). Post-EVT MTT maps demonstrated focal areas of hyperperfusion (n=8) or persisting hypoperfusion (n=3) corresponding to the regions where HT later developed. The relationship between MTT and HT was U-shaped; HT occurred in patients at both the lowest and highest extremes of MTT. An MTT threshold <2 or >4 seconds was 81% sensitive and 94% specific for classifying the presence of HT at follow-up. Conclusions- Perfusion measurements can be obtained using DSA perfusion with minimal changes to current stroke protocols. Perfusion imaging post-recanalization may have additional clinical utility beyond visual assessment of source angiographic images alone.

Complete Recanalization May Exert the Most Important Effect on Outcomes of Endovascular Treatment in Acute Ischemic Stroke with Small Infarct Core Beyond 6 Hours

To explore the differences among grades of recanalization on outcomes of endovascular treatment for acute anterior large vessel occlusion with small infarct core beyond the 6-hour time window. Patients beyond the 6-hour time window with Alberta Stroke Program Early Computed Tomography Score >7 were retrospectively enrolled from the endovascular treatment for acute anterior circulation ischemic stroke (ACTUAL) registry. They were divided into 3 groups according to the degree of recanalization: modified treatment in cerebral infarction (mTICI) 0-2a, 2b, and 3. We compared the differences of outcomes among groups on modified Rankin Scale score at 90 days, symptomatic intracerebral hemorrhage within 72 hours, and mortality. A total of 101 patients were enrolled. Median time from onset to groin puncture was 415 minutes (interquartile range: 387-497 minutes). Favorable functional outcomes were significantly better in patients with successful recanalization than in patients with failed recanalization (mTICI 0-2a, 22.7% [5/22]; mTICI 2b, 48.0% [12/25]; and mTICI 3, 61.1% [33/54]; trend P= 0.01). Complete recanalization (mTICI 3) (odds ratio, 5.34; 95% confidence interval, 1.71-16.66; P= 0.004) was associated with good functional outcome. Mortality was different among groups at 90 days (mTICI 0-2a, 36.4% [8/22]; mTICI 2b, 0, [0/25]; P= 0.001; mTICI 0-2a, 36.4% [8/22]; mTICI 3, 9.3% [5/54]; P= 0.008; and mTICI 2b, 0, [0/25]; mTICI 3, 9.3% [5/54]; P= 0.173). There were no significant differences of symptomatic intracranial hemorrhage among groups (mTICI 0-2a, 22.7% [5/22]; mTICI 2b, 12.0% [3/25]; and mTICI 3, 9.3% [5/54]; P= 0.28). For acute anterior circulation stroke patients, who were beyond the 6-hour time window, yet with small ischemic core, complete recanalization following endovascular treatment may play the most important role on clinical outcome.

Atherosclerotic intracranial internal carotid artery calcification and intravenous thrombolytic therapy for acute ischemic stroke

Background and aimsIntracranial internal carotid artery calcification (IICAC) is a frequent and readily available finding in acute stroke patients treated with intravenous (IV) tissue plasminogen activator (tPA). We aimed to investigate the effects of IICAC subtype (medial and intimal) on the response to IV tPA. MethodsIn this retrospective study, 91 (57% female, age 69 ± 13 years) consecutive acute anterior circulation stroke patients treated with IV tPA were included. IICAC were diagnosed and classified according to Kockelkoren's methods. ResultsIV tPA was effective at 24 h in 48% of patients with no IICAC (n = 27), 60% of intimal IICAC (n = 50) and 43% of medial IICAC (n = 14) (p=0.408). Presence of medial IICAC tended to be linked negatively to early dramatic response to IV tPA (p=0.052). IICAC status had no significant effect on the third month good (mRS≤2; 48% in no IICAC, 36% in intimal IICAC and 29% in medial IICAC; p=0.189) and favorable outcome (mRS≤1; 56% in no IICAC, 48% in intimal IICAC, 43% in medial IICAC, p=0.411). Frequency of symptomatic post-tPA cerebral hemorrhage was marginally higher in patients with non-intimal IICAC (21% vs. 4% in no-IICAC, 4% in intimal-IICAC, p=0.052). Exploratory multivariate analysis documented that this effect was stable (p=0.004) after adjustment for age, admission NIHSS and door-to-needle time. ConclusionsMedial type IICAC has been associated with numerical increase of symptomatic intracerebral hemorrhage and decrease of early dramatic response in stroke patients receiving IV tPA. Acknowledging that these preliminary observations should be replicated in larger cohorts, it is currently reasonable to say that “the treatment” is still useful in these patients and the presence of medial IICAC does not justify withholding IV tPA.

Clinical Effectiveness and Safety Outcomes of Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke in China

Backgrounds and Purpose: This study was aimed at investigating the outcomes and predictors for the poor functional outcome after endovascular treatment (EVT) in a large, mostly Asian population. Methods: Between January 2014 and June 2016, acute stroke patients with anterior circulation occlusion and EVT were retrospectively enrolled from 21 stroke centers in China. The main outcomes were modified Rankin Scale (0-2 as functional independence, 3-6 as poor) at 90 days, symptomatic intracranial hemorrhage (sICH) at 72 h, and death at 90 days. Logistic regression was used to identify predictors for poor functional outcome at 90 days. Results: Of the 698 patients, 304 (43.6%) patients had functional independence at 90 days. The sICH rate was 15.5% (108/698) and mortality rate at 90 days was 25.4% (177/698). Age (OR 1.04, 95% CI 1.02-1.07), National Institutes of Health Stroke Scale score at admission (11-20 vs. ≤10, OR 2.38, 95% CI 1.23-4.59; ≥21 vs. ≤10, OR 3.66, 95% CI 1.72-7.80), baseline glucose level (OR 1.09, 95% CI 1.01-1.18), onset to groin puncture >6 h (OR 1.88, 95% CI 1.06-3.31), sICH (OR 15.49, 95% CI 5.16-46.43), and pneumonia (OR 3.15, 95% CI 1.86-5.32) were independent predictors of poor functional outcomes, while good recanalization (OR 0.26, 95% CI 0.13-0.54), preoperative Alberta Stroke Program Early CT Score 8-10 (OR 0.48, 95% CI 0.28-0.83), and good collateral flow (OR 0.50, 95% CI 0.32-0.79) were protective factors. Conclusions: This study provides evidence in real world to support the performance of EVT in acute anterior circulation stroke patients in Chinese population. Patients with small infarct core, successful recanalization, good collateral status, and short treatment delay without sICH or pneumonia may benefit from EVT.

Epilepsia partialis continua after an anterior circulation ischaemic stroke.

Although cerebrovascular disorders are the main cause of epilepsia partialis continua (EPC) in adulthood, the frequency of EPC after stroke is unknown. The aim was to prospectively ascertain its frequency 1 year after an ischaemic stroke. This was a prospective study of consecutive acute anterior circulation ischaemic stroke patients, previously independent, with an admission National Institutes of Health Stroke Scale score ≥4, an acute ischaemic lesion on imaging and no previous epileptic seizures. During admission patients received standardized diagnostic and medical care and were submitted to a neurophysiological evaluation protocol. One year after stroke, patients were re-evaluated by an epilepsy expert neurologist and performed a video-electroencephalogram with electromyography co-registration whenever myoclonus was observed during neurological examination for jerk-locked back averaging analysis (JLBA). EPC was defined as continuously repeated fragments of epileptic seizures, with preserved consciousness, lasting at least 1 h, and representing locally restricted epileptic activity. In all, 151 acute anterior circulation stroke patients were consecutively included and prospectively evaluated, but 23 died in the first year. One year after stroke, from 127 patients alive, 117 (92.1%) underwent clinical and neurophysiological evaluation. In two (1.7%) patients, EPC diagnosis was made both by clinical and electroencephalographic criteria, namely JLBA. Both patients had a history of remote symptomatic seizures and one of them acute symptomatic seizures and non-convulsive status epilepticus criteria during the first 7 days after stroke. Despite its low frequency, the high stroke incidence makes post-stroke EPC relevant. This study draws attention to this recognizable condition with therapeutic and eventually prognostic implications.

Abstract 2933: Combined Clinical, CT, And CTA-SI Scale To Expect The Presence Of Large Infarct Volume On DWI In Acute Stroke Patients Within 8h Of Onset.

Background and Purpose: Large ischemic volume (&gt;70-80ml) on diffusion-weighted imaging (DWI) has been associated with a lack of response to early recanalization therapy of acute ischemic stroke. We investigated whether a scale that combines clinical, conventional computed tomography (CT) and CT angiography source imaging (CTA-SI) information can estimate large infarct of &gt;80ml seen on early DWI. Methods: Acute anterior circulation stroke patients within 8h of onset and examined with CT and CTA were prospectively enrolled. Only imaging findings evaluated within 1.5h interval among CT, CTA and DWI were analyzed. NIH Stroke Scale (NIHSS) score was assessed on admission. The Alberta Stroke Programme Early CT Score (ASPECTS) was scored on CT and CTA-SI. To devise the early infarct volume estimation scale, NIHSS score, CT and CTA-SI ASPECTSs were scored as 1, if the NIHSS score was greater than or equal to, and, CT and CTA-SI ASPECTS was smaller than or equal to the cut-off value to distinguish the DWI volume of &gt;80ml from others. Collateralization was also defined as score of 1 if collateral filling was limited &lt;50% on CTA-SI. We compared the DWI volume based on the scale, score of 0, 1, 2, 3 and 4. After that, we calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the score to estimate the DWI volume of &gt;80ml were calculated. Result: Fifty-seven subjects (median age [quartiles]; 74 [56-82], male; 28 [49%]) were enrolled from May 2010 to July 2011. DWI volume of &gt;80ml was seen in 10 (18%) patients. Using ROC curve, the cut-off value of NIHSS score to predict DWI of &gt;80ml was 20 (sensitivity of 0.70 and specificity of 0.70, area under curve [AUC] 0.761, p=0.010), that of CT ASPECTS was 6 (sensitivity of 0.98 and specificity of 0.68, AUC 0.887, p&lt;0.001), that of CTA-SI ASPECTS was 6 (sensitivity of 0.87 and specificity of 0.80, AUC 0.952, p&lt;0.001), respectively. Based on the scale, DWI volume was 14 (8-23) ml in patients with score of 0, 22 (11-36) ml with of 1, 67 (36-88) ml with of 2, 127 (71-147) ml with of 3, and 177 (131-191) ml with of 4 (p&lt;0.001). All of those with score of 0 or 1 had DWI volume of ≤80ml (sensitivity of 1.00, specificity of 0.87 PPV of 1.00, and NPV of 0.62 (p&lt;0.001). Seven (54%) of the 13 patients with score of 2 or 3 had DWI volume of &gt;80ml (sensitivity of 0.70, specificity of 0.87, PPV of 0.54, and NPV of 0.93, p&lt;0.001), and all of the 3 patients with score of 4 had DWI volume of &gt;80ml (sensitivity of 0.30, specificity of 1.00, PPV of 1.00, and NPV of 0.87, p=0.004). Conclusion: Clinical and CT based radiological examinations may estimate the large ischemic volume on early DWI.

Diffusion weighted MRI imaging and MES detection in the assessment of stroke origin

Objectives: This study compares the additional benefit of diffusion-weighted MRI (DWI) and microembolus detection by transcranial Doppler ultrasonography (TCD) in the assessment of stroke etiology.Methods: Fifty-five acute anterior circulation stroke or TIA patients were investigated by both cranial DWI and bilateral TCD of the middle cerebral arteries (1 hour).Results: In one of the 13 patients without acute ischemic lesions visualized on DWI, microembolic signal (MES) detection was positive. However, in 33 out of 44 patients without MES, DWI revealed at least one lesion. In two patients with unilateral territorial infarction and otherwise normal cardiovascular work-up, bilateral MES were found thus localizing the embolic source into the aortic arch or the heart. In a further patient with a dissection, the occurrence of contralateral MES raised doubts on a dissection to be the cause of the infarct.Discussion: There is a contribution of both techniques to the understanding of stroke etiology. The impact of DWI is, however, superior to that of MES detection. Longer TCD recording times may diminish this discrepancy.

Leukoaraiosis Is a Risk Factor for Symptomatic Intracerebral Hemorrhage After Thrombolysis for Acute Stroke

The aim of the study was to evaluate whether leukoaraiosis (LA) is a risk factor for symptomatic intracerebral hemorrhage (sICH) in patients treated with thrombolysis for acute stroke. In this retrospective, multicenter analysis, we evaluated data from acute anterior circulation stroke patients (n=449; <6 hours after symptom onset) treated with thrombolysis. All patients had received standard magnetic resonance imaging evaluation before thrombolysis, including a high-quality T2-weighted sequence. For the analysis, LA in the deep white matter was dichotomized into absent or mild versus moderate or severe (corresponding to Fazekas scores of 0 to 1 versus 2 to 3). The rate of sICH was significantly more frequent in patients with moderate to severe LA of the deep white matter (n=12 of 114; 10.5%) than in patients without relevant LA (n=13 of 335; 3.8%), corresponding to an odds ratio of 2.9 (95% CI, 1.29 to 6.59; P=0.015). In a logistic-regression analysis (including age, National Institutes of Health Stroke Scale score at presentation, and type of thrombolytic treatment), LA remained a significant independent risk factor (odds ratio, 2.9; P=0.03). LA of the deep white matter is an independent risk factor for sICH after thrombolytic treatment for acute stroke.