Association between the overall burden of cerebral small vascular disease and the hemorrhagic transformation of acute ischemic stroke after intravenous thrombolysis
10.19845/j.cnki.zfysjjbzz.2023.0198
- VernacularTitle:脑小血管病总体负担与急性缺血性卒中静脉溶栓后出血转化的相关性分析
- Author:
Yanwen FANG
1
;
Wei WANG
1
Author Information
1. Department of Neurology， Civil Aviation General Hospital， Beijing 100123， China
- Publication Type:Journal Article
- Keywords:
Cerebral small vascular disease;
Ischemic stroke;
Intravenous thrombolysis
- From:
Journal of Apoplexy and Nervous Diseases
2023;40(10):916-921
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the association between the overall burden of cerebral small vascular disease （CSVD） and the hemorrhagic transformation of acute ischemic stroke after intravenous thrombolysis. Methods A retrospective analysis was performed for 268 patients with acute ischemic stroke who received rt-PA intravenous thrombolysis in our hospital from January 2019 to October 2022, and according to the presence or absence of hemorrhagic transformation after thrombolysis, they were divided into hemorrhagic transformation group and non-hemorrhagic transformation group. Related data were collected for both groups, including demographic information （sex, age）, smoking history, medical history （hypertension, diabetes, hyperlipidemia, coronary heart disease, atrial fibrillation, and ischemic stroke）, and clinical data after onset, such as onset-to-treatment time （OTT）, systolic pressure/diastolic pressure/blood glucose at baseline, laboratory findings within 24 hours after onset [fasting blood glucose, glycated hemoglobin, homocysteine, creatinine, triglyceride, total cholesterol, high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C）, uric acid, platelet, prothrombin time （PT）, international normalized ratio （INR）, fibrinogen, fibrinogen, C-reactive protein （CRP）], location of infarction （anterior circulation or posterior circulation）, TOAST typing, and the overall burden of CSVD （mild, moderate or severe）. The two groups were compared in terms of baseline data, clinical data, and CSVD score, and the logistic regression analysis was used to investigate the association between the overall burden of CSVD and hemorrhagic transformation after intravenous thrombolysis. Results A total of 268 patients with acute ischemic stroke who received intravenous thrombolysis were enrolled, with an age of 23-97 years （mean 65.5 years）, and male patients accounted for 70.5% （189/268）. The baseline NIHSS score was 7.5 （0, 27） points, and OTT was 151.2 （20, 270） minutes. Among these patients, 138 （51.4%） had moderate to severe WMH, 193 （72.0%） had lacunar infarction, 56（20.8%） had cerebral microbleeds,and 106（39.5%） had perivascular spaces. There were 115 patients（42.9%） in the mild CSVD group,65（24.2%） in the moderate CSVD group,and 88 （32.8%） in the severe CSVD group. There were 29 patients with hemorrhagic transformation （10.3%）. Atrial fibrillation （odds ratio OR=5.628,95%CI 1.862-17.009,P=0.002）,cerebral microbleeds （OR=4.062,95%CI 1.437-11.485,P=0.008）, and baseline NIHSS score （OR=1.182,95%CI 1.082-1.292,P<0.001） were independent risk factors for hemorrhagic transformation after thrombolysis, and with mild CSVD as the reference, severe CSVD（OR=0.694,95%CI 1.458-9.360,P=0.006） was independently associated with hemorrhagic transformation. Conclusion The overall burden of CSVD in patients with acute ischemic stroke is closely associated with hemorrhagic transformation after intravenous thrombolysis, and severe CSVD is an independent risk factor for hemorrhagic transformation after intravenous thrombolysis.
- Full text:2024061322002320091脑小血管病总体负担与急性缺血性卒中静脉溶栓后出血转化的相关性分析.pdf
