Does Leukoaraiosis Have Any Significance in TPA Treated Patients?
Background: Leukoaraiosis (LA) has been associated with increased risk of hemorrhage in patients treated with anticoagulants in the SPIRIT, and has been associated with a higher incidence of deep intracerebral hemorrhages (ICH). Individuals with LA have a higher risk of death, and dependency 3 months after cerebral ischemia, recurrent strokes, MI, vascular deaths, and post-stroke dementia. Given the frequency of LA on CT, and its association with increased risk for hemorrhage with anticoagulants, this could represent a predictable risk for stroke patients about to receive TPA. We examined the correlation of LA with stroke severity, risk of hemorrhage, short-term outcome after TPA and associated stroke risk factors. Methods:We evaluated pre-treatment, non-contrast CT scans in patients with Middle Cerebral Artery (MCA) strokes, for the presence and extent of LA using the van Swieten rating system. The NIHSS scores were obtained at baseline and 24 hours. Lesion volumes were determined on a follow-up scan using the (A*B*C)/2 method. Admission systolic BP and glucose were also obtained. Results: A total of 54 TPA-treated patients were studied, aged (mean ±SD) 68 years ±14.9, and baseline NIHSS 16.5 ±6.1 (n=45). Leukoaraiosis was found in 37%(20/54) of all patients on pre-treatment CT scans. No relationship was found between LA presence on pre-treatment CT scans and hemorrhagic transformation, NIHSS scores at baseline and 24 hrs, age, gender, serum glucose, and ASPECT scores. There was, however, a negative correlation between LA scores and ASPECT scores (r=-0.32 p=0.05). Systolic blood pressure correlated significantly (r=0.38, p=0.01) with LA score. There was a non-significant trend towards higher LA scores and increasing age.