Â鶹´«Ã½Ó³»­

Â鶹´«Ã½Ó³»­

Explore the latest content from across our publications
Join The Â鶹´«Ã½Ó³»­

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

White Matter Score Does Not Predict Post-tpa Hemorrhage In Elderly Patients Evaluated Acutely Via Telestroke
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
165
Assess the association of CT-based age-related white matter changes (ARWMC) with  symptomatic intracranial hemorrhage (sICH) in elderly patients.

Increasing age may augment risk of post-tPA sICH. ARWMC are associated with sICH. Patients evaluated for ischemic stroke via telestroke may not have access to MRI to allow incorporation of microbleeds in tPA decisions.

Patients ≥80 years who received tPA at a spoke hospital were selected from our telestroke registry (9/2015-12/2019). Spoke CT scans were reviewed by three authors for periventricular white matter changes (PWMC) and deep white matter changes (DWMC). ARWMC, based on Fazekas score, was mild (0-2), moderate (3-4), or severe (5-6). PWMC and DWMC were mild (0-1) or moderate-severe (2-3). Logistic regression (adjusting for age, sex, race, ethnicity, NIHSS, and mRS) analyzed the relationship of ARWMC scores with sICH. 

Of 341 patients, median age was 86 (IQR 82-90), and 66% were female. The median ARWMC score was 3 (IQR 2-5). More severe ARWMC scores did not lead to increased post-tPA ICH (moderate OR 0.84, CI 0.27-2.59; severe OR 2.42, CI 0.85-6.88) including sICH (moderate OR 0.69, CI 0.28-1.68; severe OR 1.55, CI 0.67-3.62). Severe PWMC and DWMC were not associated with increased risk of post-tPA ICH (PWMC OR 1.73, CI 0.65-4.65; DWMC OR 1.74, CI 0.73-4.15), including sICH (PWMC OR 1.36, 0.62-2.98; DWMC OR 1.31, CI 0.64-2.68). In our cohort, older patients had no difference in hemorrhage (ICH OR 0.96 CI 0.90-1.02; sICH OR 0.96 CI 0.89-1.03), and higher NIHSS was associated with hemorrhage (ICH OR 1.06 CI 1.02-1.09; sICH OR 1.08 CI 1.03-1.12). CT scan readers had moderate IRR (k=0.504).
ARWMC scores were not associated with post-tPA ICH in the elderly. Our analysis supports use of tPA despite severity of white matter disease. ARWMC should not assist in tPA decision-making in elderly patients via telestroke.
Authors/Disclosures
Muhammad Bilal Tariq, MBBS (UT health Science Center at Houston)
PRESENTER 		Dr. Tariq has nothing to disclose.
Lamya Ibrahim, MD, MBBS (Hospital of the University of Pennsylvania) Dr. Ibrahim has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Alicia Zha, MD (The Ohio State University Wexner Medical Center) The institution of Dr. Zha has received research support from Â鶹´«Ã½Ó³»­. The institution of Dr. Zha has received research support from American Board of Psychiatry and Neurology.
Tiffany Cossey, MD (University of Texas, Houston) Dr. Cossey has nothing to disclose.
Tzu-Ching Wu, MD (UT Health McGovern Medical School) Dr. Wu has nothing to disclose.
Sean I. Savitz, MD Dr. Savitz has nothing to disclose.
Amanda Jagolino-Cole, MD, FÂ鶹´«Ã½Ó³»­ (University of Texas Health Science Center At Houston) Dr. Jagolino-Cole has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Â鶹´«Ã½Ó³»­ - Neurology Clinical Practice Journal. .