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Leukoaraiosis is associated with poor outcomes after successful recanalization for large vessel occlusion stroke

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Abstract

Background

Leukoaraiosis (LA) is related to the dysfunction of the microcirculation and results in the impairment of the perfusion state. We investigated the association of LA and poor outcomes after successful recanalization by thrombectomy.

Methods

We retrospectively analyzed 97 patients with anterior large-artery occlusion who underwent thrombectomy and had successful recanalization (modified Treatment in Cerebral Ischemia Scale score 2b or 3). All patients underwent magnetic resonance imaging (MRI). LA was evaluated using fluid-attenuated inversion recovery MRI and graded using the Fazekas scale. Poor functional outcome at day 90 and symptomatic intracerebral hemorrhage (sICH) were compared between patients with absent to mild LA and moderate to severe LA. Logistic regression analyses were performed to determine the association of LA severity and outcomes.

Results

Moderate and severe LA occurred in 28.9% and 26.8% patients respectively. A higher proportion of poor outcomes were observed in patients with moderate to severe LA compared to patients with absent to mild LA (77.8% vs. 39.5%, p < 0.001). Logistic regression analyses showed patients with moderate to severe LA had 3.77 times (95%CI 1.21–11.76, p = 0.022) higher risk of having poor outcomes compared to patients with absent to mild LA.

Conclusions

LA severity may be associated with poor outcomes after successful recanalization for ischemic stroke with anterior large vessel occlusion.

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References

  1. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, Johnston KC, Johnston SC, Khalessi AA, Kidwell CS, Meschia JF, Ovbiagele B, Yavagal DR (2015) 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46(10):3020–3035

    Article  CAS  PubMed  Google Scholar 

  2. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL (2018) 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49:e46–e110

    Article  Google Scholar 

  3. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378(1):11–21

    Article  PubMed  Google Scholar 

  4. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Davalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millan M, Davis SM, Roy D, Thornton J, Roman LS, Ribo M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet (London, England) 387(10029):1723–1731

    Article  Google Scholar 

  5. Fierini F, Poggesi A, Pantoni L (2017) Leukoaraiosis as an outcome predictor in the acute and subacute phases of stroke. Expert Rev Neurother 17(10):963–975

  6. Prins ND, Scheltens P (2015) White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol 11(3):157–165

    Article  PubMed  Google Scholar 

  7. Streifler J, Maillard P (2017) Thrombolysis for acute ischemic stroke in patients with leukoaraiosis: caution needed. Neurology 88(7):612–613

    Article  PubMed  Google Scholar 

  8. Ryu WS, Woo SH, Schellingerhout D, Jang MU, Park KJ, Hong KS, Jeong SW, Na JY, Cho KH, Kim JT, Kim BJ, Han MK, Lee J, Cha JK, Kim DH, Lee SJ, Ko Y, Cho YJ, Lee BC, Yu KH, Oh MS, Park JM, Kang K, Lee KB, Park TH, Lee J, Choi HK, Lee K, Bae HJ, Kim DE (2017) Stroke outcomes are worse with larger leukoaraiosis volumes. Brain 140(Pt 1):158–170

    Article  PubMed  Google Scholar 

  9. Kongbunkiat K, Wilson D, Kasemsap N, Tiamkao S, Jichi F, Palumbo V, Hill MD, Buchan AM, Jung S, Mattle HP, Henninger N, Werring DJ (2017) Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis. Neurology 88(7):638–645

    Article  PubMed  PubMed Central  Google Scholar 

  10. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372(11):1009–1018

    Article  CAS  Google Scholar 

  11. Nighoghossian N, Abbas F, Cho TH, Geraldo AF, Cottaz V, Janecek E, Mechtouff L, Bischoff M, El Khoury C, Schott AM, Derex L, Hermier M, Tisserand LG, Amelie R, Chamard L, Berthezene Y (2016) Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis. Neuroradiology 58(10):961–967

    Article  PubMed  Google Scholar 

  12. Neumann-Haefelin T, Hoelig S, Berkefeld J, Fiehler J, Gass A, Humpich M, Kastrup A, Kucinski T, Lecei O, Liebeskind DS, Rother J, Rosso C, Samson Y, Saver JL, Yan B (2006) Leukoaraiosis is a risk factor for symptomatic intracerebral hemorrhage after thrombolysis for acute stroke. Stroke 37(10):2463–2466

    Article  PubMed  Google Scholar 

  13. Guo Y, Zi W, Wan Y, Zhang S, Sun B, Shang X, Li S, Bai Y, Li Z, Zheng D, Liu X (2018) Leukoaraiosis severity and outcomes after mechanical thrombectomy with stent-retriever devices in acute ischemic stroke. Journal of Neurointerventional Surgery. https://doi.org/10.1136/neurintsurg-2018-014018

  14. Charidimou A, Pasi M, Fiorelli M, Shams S, von Kummer R, Pantoni L, Rost N (2016) Leukoaraiosis, cerebral hemorrhage, and outcome after intravenous thrombolysis for acute ischemic stroke: a meta-analysis (v1). Stroke 47(9):2364–2372

    Article  PubMed  PubMed Central  Google Scholar 

  15. Arba F, Palumbo V, Boulanger JM, Pracucci G, Inzitari D, Buchan AM, Hill MD (2016) Leukoaraiosis and lacunes are associated with poor clinical outcomes in ischemic stroke patients treated with intravenous thrombolysis. Int J Stroke 11(1):62–67

    Article  PubMed  Google Scholar 

  16. Liu J, Tseng BY, Khan MA, Tarumi T, Hill C, Mirshams N, Hodics TM, Hynan LS, Zhang R (2016) Individual variability of cerebral autoregulation, posterior cerebral circulation and white matter hyperintensity. J Physiol 594(11):3141–3155

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Indelicato E, Fanciulli A, Poewe W, Antonini A, Pontieri FE, Wenning GK (2015) Cerebral autoregulation and white matter lesions in Parkinson's disease and multiple system atrophy. Parkinsonism Relat Disord 21(12):1393–1397

    Article  PubMed  Google Scholar 

  18. Montagne A, Nikolakopoulou AM, Zhao Z, Sagare AP, Si G, Lazic D, Barnes SR, Daianu M, Ramanathan A, Go A, Lawson EJ, Wang Y, Mack WJ, Thompson PM, Schneider JA, Varkey J, Langen R, Mullins E, Jacobs RE, Zlokovic BV (2018) Pericyte degeneration causes white matter dysfunction in the mouse central nervous system. Nat Med 24:326–337

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hall CN, Reynell C, Gesslein B, Hamilton NB, Mishra A, Sutherland BA, O'Farrell FM, Buchan AM, Lauritzen M, Attwell D (2014) Capillary pericytes regulate cerebral blood flow in health and disease. Nature 508(7494):55–60

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Wei CC, Zhang ST, Wang YH, Liu JF, Li J, Yuan RZ, Tan G, Zhang SH, Liu M (2017) Association between leukoaraiosis and hemorrhagic transformation after cardioembolic stroke due to atrial fibrillation and/or rheumatic heart disease. J Neurol Sci 378:94–99

    Article  PubMed  Google Scholar 

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Funding

Nan**g Commission of Health and Family Planning, China (grant number ZDX16002) funded this study.

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Correspondence to Junshan Zhou or Yingdong Zhang.

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The authors declare that they have no conflicts of interest.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and national research committee and adhered to the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Liu, Y., Gong, P., Sun, H. et al. Leukoaraiosis is associated with poor outcomes after successful recanalization for large vessel occlusion stroke. Neurol Sci 40, 585–591 (2019). https://doi.org/10.1007/s10072-018-3698-2

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  • DOI: https://doi.org/10.1007/s10072-018-3698-2

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