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Small vessel disease and clinical outcomes after IV rt-PA treatment.
Arba, F; Inzitari, D; Ali, M; Warach, S J; Luby, M; Lees, K R.
Afiliación
  • Arba F; NEUROFARBA Department, University of Florence, Florence, Italy.
  • Inzitari D; Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK.
  • Ali M; NEUROFARBA Department, University of Florence, Florence, Italy.
  • Warach SJ; Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK.
  • Luby M; Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
  • Lees KR; National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.
Acta Neurol Scand ; 136(1): 72-77, 2017 Jul.
Article en En | MEDLINE | ID: mdl-28233290
INTRODUCTION: 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. CONCLUSION: 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Accidente Cerebrovascular / Enfermedades de los Pequeños Vasos Cerebrales Tipo de estudio: Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Acta Neurol Scand Año: 2017 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Dinamarca

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Accidente Cerebrovascular / Enfermedades de los Pequeños Vasos Cerebrales Tipo de estudio: Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Acta Neurol Scand Año: 2017 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Dinamarca