PT - JOURNAL ARTICLE AU - Candice Delcourt AU - Xia Wang AU - Zien Zhou AU - Joanna M Wardlaw AU - Grant Mair AU - Thompson G Robinson AU - Xiaoying Chen AU - Sohei Yoshimura AU - Takako Torii-Yoshimura AU - Cheryl Carcel AU - Zeljka Calic AU - Wee Yong Tan AU - Alejandra Malavera AU - Craig S Anderson AU - Richard I Lindley TI - Brain imaging abnormalities and outcome after acute ischaemic stroke: the ENCHANTED trial AID - 10.1136/jnnp-2020-323015 DP - 2020 Oct 14 TA - Journal of Neurology, Neurosurgery & Psychiatry PG - jnnp-2020-323015 4099 - http://jnnp.bmj.com/content/early/2020/10/14/jnnp-2020-323015.short 4100 - http://jnnp.bmj.com/content/early/2020/10/14/jnnp-2020-323015.full AB - Objective To test the hypothesis that imaging signs of ‘brain frailty’ and acute ischaemia predict clinical outcomes and symptomatic intracranial haemorrhage (sICH) after thrombolysis for acute ischaemic stroke (AIS) in the alteplase dose arm of ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED).Methods Blinded assessors coded baseline images for acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions; and hyperattenuated arteries) and pre-existing changes (atrophy, leucoaraiosis and old ischaemic lesions). Logistic regression models assessed associations between imaging features and death at 7 and 90 days; good recovery (modified Rankin Scale scores 0–2 at 90 days) and sICH. Data are reported with adjusted ORs and 95% CIs.Results 2916 patients (67±13 years, National Institutes of Health Stroke Scale 8 (5–14)) were included. Visible ischaemic lesions, severe hypoattenuation, large ischaemic lesion, swelling and hyperattenuated arteries were associated with 7-day death (OR (95% CI): 1.52 (1.06 to 2.18); 1.51 (1.01 to 2.18); 2.67 (1.52 to 4.71); 1.49 (1.03 to 2.14) and 2.17 (1.48 to 3.18)) and inversely with good outcome. Severe atrophy was inversely associated with 7-day death (0.52 (0.29 to 0.96)). Atrophy (1.52 (1.08 to 2.15)) and severe leucoaraiosis (1.74 (1.20 to 2.54)) were associated with 90-day death. Hyperattenuated arteries were associated with sICH (1.71 (1.01 to 2.89)). No imaging features modified the effect of alteplase dose.Conclusions Non-expert-defined brain imaging signs of brain frailty and acute ischaemia contribute to the prognosis of thrombolysis-treated AIS patients for sICH and mortality. However, these imaging features showed no interaction with alteplase dose.