Leukoaraiosis is a risk factor for symptomatic intracerebral hemorrhage after thrombolysis for acute stroke

Background and Purpose-The aim of the study was to evaluate whether leukoaraiosis (LA) is a risk factor for symptomatic intracerebral hemorrhage (sICH) in patients treated with thrombolysis for acute stroke. Methods-In this retrospective, multicenter analysis, we evaluated data from acute anterior circulation stroke patients (n=449; < 6 hours after symptom onset) treated with thrombolysis. All patients had received standard magnetic resonance imaging evaluation before thrombolysis, including a high-quality T2-weighted sequence. For the analysis, LA in the deep white matter was dichotomized into absent or mild versus moderate or severe (corresponding to Fazekas scores of 0 to 1 versus 2 to 3). Results-The rate of sICH was significantly more frequent in patients with moderate to severe LA of the deep white matter (n= 12 of 114; 10.5%) than in patients without relevant LA (n= 13 of 335; 3.8%), corresponding to an odds ratio of 2.9 (95% CI. 1.29 to 6.59; P=0.015). In a logistic-regression analysis (including age, National Institutes of Health Stroke Scale score at presentation, and type of thrombolytic treatment), LA remained a significant independent risk factor (odds ratio, 2.9; P=0.03). Conclusions-LA of the deep white matter is an independent risk factor for sICH after thrombolytic treatment for acute stroke.