This study aims to investigate the relationship between the severity of leukoaraiosis and post-thrombolytic intracerebral hemorrhage (ICH) in patients with acute cerebral infarction undergoing thrombolytic therapy. It also analyzes the characteristics of cases involving ICH after thrombolysis.

We collected information on patients receiving alteplase thrombolytic therapy at Xiling Branch of Yichang Central People’s Hospital from January 1, 2017, to December 31, 2023. The severity of leukoaraiosis was scored using the Van Swieten method, and the association between different severity groups and post-thrombolytic ICH was analyzed.

This study included 618 patients. Analysis showed that the incidence of ICH following thrombolysis was significantly lower in the mild leukoaraiosis group (3.23 %, 15/480 cases) compared to the moderate-to-severe group (15 %, 18/138 cases; P < 0.005), highlighting the critical impact of leukoaraiosis severity on post-thrombolytic ICH risk. Overall, 33 patients developed ICH after thrombolysis. Among these, large-artery atherosclerotic stroke was the most common TOAST subtype (9.23 %, 18/195 cases). NIHSS scores > 8 was associated with an increased risk of ICH, which peaked at 15.65 % (18/115 cases) for scores between 8 and 16 (inclusive of 8, exclusive of 16). Regarding outcomes, 10 out of the 33 patients with post-thrombolysis ICH died. Notably, PH2-type hemorrhagic transformation predominated, accounting for 60 % of deaths and 43.48 % of non-fatal cases, while no HI1-type hemorrhages were observed among deceased patients.

Patients with higher leukoaraiosis scores face increased post-thrombolytic ICH risk. Large-artery atherosclerotic infarction and higher NIHSS scores also elevate ICH risk post-thrombolysis, with PH2-type hemorrhagic transformation more prevalent in death group than non-death group.

This study was supported by Yichang Medical and Health Research Foundation in 2022 (number: A22-2-030) and Key Research and Development Project of Hubei Province (number: 2022BCE046).