| Part 1 The relationship between leukoaraiosis(LA)and intracranial hemorrhagic transformation(HT)after intravenous thrombolysis(IVT)in elderly patients with acute cerebral infarction(ACI).Objective:(1)To evaluate whether LA and different degrees of LA have an impact on intracranial HT after IVT in elderly patients with ACI.(2)To evaluate whether LA and different degrees of LA have an effect on symptomatic intracranial hemorrhage(s ICH)after IVT in elderly patients with ACI.Method:(1)We consecutively chose the elderly patients aged≥60 years with ACI who were treated with IVT in Beijing Huairou Hospital from January 2016 to October 2021.(2)Before IVT,all patients were examined by head CT(computed tomography)scan,and LA was evaluated by m VSS score.After IVT,the head CT was rechecked on 24 hours and 36 hours or head MRI(magnetic resonance image)was conducted on 36 hours to determine the focus lesion and whether there was cerebral HT.If the patients’ condition worsen and intracranial hemorrhage was suspected,head CT can be examined at any time.SICH was evaluated according to ECASSⅢ standard,but the evaluation time was 24 to 36 hours after IVT.(3)We divided the patients into two groups according to whether with LA or not and compared the incidences of intracranial HT and s ICH between the two groups,and then we compared the rates of HT and s ICH among different groups after these groups divided according to LA severity.Finally,we evaluated whether there were relations between LA or not,LA severity and HT or s ICH.Results:(1)A total of 240 patients were included and 157 cases were males,aged from 60 to 96 years with an average age of 73.0±8.0 years.There were 69 cases without LA and 171 cases with LA,of whom 92 cases with mild LA and 79 cases with severe LA according to CT.After IVT,there were 19 cases happened s ICH and 32 cases complicated of intracranial HT including 12 cases of bleeding infarction,1 case of small hematoma,and 19 cases of large hematoma with3 cases of distant hemorrhage.There were 5 cases of HT and 3 cases of s ICH in without LA group,and 27 cases of HT and 16 cases of s ICH in LA group.The rates of HT and s ICH in mild LA group and severe LA group were 10.9%,6.5% versus(vs)21.5%,12.7% respectively.A total of 149 patients were completed head MRI on 36 hours after IVT and Fazekas scores were used to evaluate LA: 4 patients without LA and 1 case of s ICH,56 cases with mild LA and 4 cases of HT including 2 cases of s ICH,49 cases with moderate LA and 5 cases of HT including 4 cases of s ICH,and 40 cases with severe LA and 5 cases of HT including 3 cases of s ICH.38 cases were accepted of head SWI(susceptibility weighted imaging)and 18 cases with cerebral microbleed(CMB)including 1 case with the number of CMB more than 10.Among 18 patients,there were 13 cases both with LA and CMB,and 5 cases without LA.(2)Univariate analysis showed that there were no statistical differences in the occurrences of HT and s ICH between LA and without LA groups.Furthermore there were no significant differences in the incidences of s ICH among the three groups(without LA,mild LA,and severe LA)but not HT.Except a difference between without LA and severe LA group,there were no statistical differences in HT between without LA vs mild LA groups,and mild LA vs severe groups.These differences in severe LA and stroke severity but not LA between HT or not HT groups were statistical,and there were no statistical differences in LA even severe LA between s ICH or not s ICH groups only except for stroke severity.(3)The results of binary Logistic regression analysis showed that severe LA based on head CT and the severity of stroke(NIHSS)were the risk factors of HT in elderly patients.Meanwhile the Logistic regression analysis showed that NIHSS was the only independent risk factor of s ICH in elderly patients with ACI undergoing IVT,but there were no correlations between LA,even severe LA and s ICH.Conclusion:(1)Severe LA based on cranial CT is related to intracranial HT and increases the risk of intracranial HT of elderly patients with ACI after IVT.(2)LA even severe LA based on cranial CT are not related to s ICH of elderly patients with ACI after IVT.Part 2 The relationship between LA and the short-time prognosis in elderly patients with ACI after IVT.Objective:(1)To evaluate whether LA or LA severity affect the poor prognosis of elderly patients ACI infarction at 3 months after IVT.(2)To evaluate whether LA or LA severity increase the risk of death of elderly patients with ACI in 3 months after IVT.Method:(1)The elderly patients aged≥60 years with ACI who were treated with IVT were consecutively selected in Beijing Huairou Hospital from January 2016 to October 2021.(2)All patients were examined by CT scan,and LA were scored by m VSS before IVT.The prognosis of patients were evaluated by face-to-face or telephone follow-up at 3 months after IVT.The function of patients were evaluated by m RS scores,and the time or causes of death of patients were truthful recorded.(3)We firstly divided the patients into two groups according to whether with LA or not,compared the rates of the adverse prognosis and death between the two groups and finally analyzed the relationships between LA and prognosis or death.Meanwhile we stratified the group with LA according to LA severity(mild or severe),compared the incidences of the adverse prognosis or death among these groups and assessed the relations between LA severity and poor prognosis or death.Results:(1)A total of 239 patients were qualified including 157 males,aged from 60 to 96 years and the average age were 72.9±8.0 years.Head CT examinations showed that there were 170 cases with LA,including 91 cases with mild LA and 79 cases with severe LA.At 3 months after IVT,there were 135 cases with poor prognosis,of whom 25 cases without LA,110 cases with LA of whom 53 cases with mild LA and 57 cases with severe LA.A total of 13 patients died in this study,including 1 case without LA,6 cases with mild LA and 6 cases in severe LA group.The causes of death: 3 cases died of s ICH,6 cases died of cerebral hernia caused by massive cerebral infarction,1 case died of vascular reocclusion,1 case died of complication of pulmonary infection,1 case died of multiple organs failure caused by digestive system tumor,and 1 case died of accident.(2)Univariate analysis showed that there were statistical differences among theses groups:with LA vs not LA groups,no LA vs mild LA groups,and no LA vs severe LA groups but not mild vs severe LA groups in the rate of poor prognosis at 3 months after IVT.At the same time,there were differences in age、stroke severity、s ICH、HT、coronary heart disease(CAD)、atrial fibrillation(AF)and heart failure(HF)between the poor and good prognosis groups.The KM analysis showed that there were no statistical differences in the rates of LA even severe LA rather than s ICH,severe stroke(NIHSS≥15),CAD and renal insufficiency(RI)between survival vs death groups.(3)The binary logistic regression analysis showed that LA、stroke severity、HF and HT were related to the clinical prognosis for elderly patients with ACI at 3 months after IVT,and probably so was severe LA compared to without LA.The COX regression analysis showed that LA even severe LA was not related to the survival or not,and so did age、s ICH and CAD,but the stroke severity and RI affected the survival of elderly patients within 3 months after IVT.Conclusion:(1)LA evaluated on cranial CT is related to the poor prognosis of elderly patients with ACI at3 months after IVT and severe LA compared to without LA probably increase the risk of adverse prognosis.(2)LA even severe LA may not increase the risk of death of elderly patients with ACI in 3months after IVT,but the evidence from this study is limited. |
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