Correlation between white matter hyperintensity and early neurological deterioration after intravenous recombinant tissue plasminogen activator thrombolysis in acute ischemic stroke patients
10.3760/cma.j.cn115354-20211216-00820
- VernacularTitle:脑白质高信号与急性缺血性脑卒中静脉溶栓后早期神经功能恶化的相关性研究
- Author:
Xueyun LIU
1
;
Qi FANG
;
Xiaosan WU
;
Sunhong YAN
;
Long WANG
;
Chuanqin FANG
Author Information
1. 安徽医科大学第二附属医院神经内科，合肥 230601
- Keywords:
White matter hyperintensity;
Leukoaraiosis;
Acute ischemic stroke;
Intravenous thrombolysis;
Early neurological deterioration
- From:
Chinese Journal of Neuromedicine
2022;21(3):257-262
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effects of white matter hyperintensity (WMH) of different lesion areas and severities on early neurological deterioration (END) in acute ischemic stroke (AIS) patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.Methods:Three hundred and seventy-three AIS patients, admitted to our hospital from April 2019 to July 2021, were chosen in our study. These patients were treated with intravenous rt-PA thrombolysis within 4.5 h of onset. According to the presence or absence of END, these patients were divided into END group ( n=89) and non-END group ( n=284). Fazekas scale was used to assess the periventricular WMH (PVWMH) and subcortical WMH (SCWMH): none-mild PVWMH/SCWMH was defined at 0-1 score and moderate to severe PVWMH/SCWMH was defined at 2-3 scores; the sum scores of the two sites were calculated, and none-mild WMH was defined at 0-2 scores and moderate-severe WMH was defined at 3-6 scores. Univariate analysis was used to compare the baseline data of the two groups, and multivariate Logistic regression was used to determine the correlations of END with WMH lesion areas and severities. Results:Univariate analysis showed that there was significant difference between the END group and non-END group in age, baseline blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) scores, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, hemorrhagic transformation after thrombolysis, and PVWMH, SCWMH, and WMH scores ( P<0.05). Multivariate Logistic analysis showed that only baseline NIHSS scores ( OR=1.064, 95%CI: 1.019-1.111, P=0.005), hemorrhagic transformation after thrombolysis ( OR=3.931, 95%CI: 2.007-7.701, P=0.000), moderate-severe WMH ( OR=4.736, 95%CI: 2.737-8.195, P=0.000), and moderate-severe SCWMH ( OR=5.557, 95%CI: 3.156-9.783, P=0.000) were independently related to the occurrence of END. Conclusion:Patients with moderate-severe SCWMH, moderate-severe WMH, or high NIHSS scores after thrombolysis trend to have END.
