Plasma tPA-Activity and progression of cerebral white matter hyperintensities in lacunar stroke patients

Abstract

Introduction Tissue plasminogen activator (tPA)-Activity and plasminogen activator inhibitor type 1 (PAI-1) antigen are considered to be haemostasis-related markers of endothelial activation and relate to presence of cerebral white matter hyperintensities (WMH) as was earlier shown in a cross-sectional study.We investigated whether tPA-Activity and PAI-1 levels are associated with WMH progression in a longitudinal study. Methods In 127 first-ever lacunar stroke patients in whom baseline brain MRI and plasma levels of tPA-Activity and PAI-1-Antigen were available, we obtained a 2-year follow-up MRI. We assessed WMH progression by a visual WMH change scale. We determined the relationship between levels of tPA-Activity and PAI-1 and WMH progression, by logistic regression analysis. Results Plasma tPA-Activity was associated with periventricular WMH progression (OR 2.36, 95% CI 1.01-5.49, with correction for age and sex and baseline presence of WMH), but not with deep or any (periventricular and/or deep) WMH progression. PAI-1 levels were lower in patients with WMH progression, but these results were not significant. Conclusion We found a relationship between plasma tPA-Activity and progression of periventricular WMH. More research is needed to determine whether there is a (direct) role of tPA in the development and progression of WMH.