Leukoaraiosis and earlier neurological outcome after mechanical thrombectomy in acute ischemic stroke - 15/02/20

Doi : 10.1016/j.neurad.2019.10.005

Yongtao Guo ^a,^b,^{^{1
These authors contributed equally to this work.}}, Shuai Zhang ^a,^c,^{^{1
These authors contributed equally to this work.}}, Mingchao Li ^b, Bo Sun ^a,^b, Xianjin Shang ^a,^d, Shun Li ^e, Yongjie Bai ^a,^f, Zibao Li ^a,^d, Wenjie Zi ^a,⁎ , Xinfeng Liu ^a,^e,⁎
^a Department of Neurology, Jinling Clinical College of Nanjing Medical University, 305 East Zhongshan Road, 210002 Nanjing, Jiangsu, China
^b Department of Neurology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing Medical University, 223300 Huai’an, Jiangsu, China
^c Department of Neurology, the Affiliated Hospital of Yangzhou University, Yangzhou University, 225001 Yangzhou, Jiangsu, China
^d Department of Neurology, Yijishan Hospital of Wannan Medical College, 241001 Wuhu, Anhui, China
^e Department of Neurology, Jinling Hospital, Southern Medical University, 210002 Nanjing, Jiangsu, China
^f Department of Neurology, First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, 471003 Luoyang, China

^⁎Corresponding author at: Department of Neurology, Jinling Clinical College of Nanjing Medical University, 305 East Zhongshan Road, 210002 Nanjing, Jiangsu, China.Department of Neurology, Jinling Clinical College of Nanjing Medical University305 East Zhongshan RoadNanjing, Jiangsu210002China

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Graphical abstract

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Highlights

•	Severe leukoaraiosis was inversely associated with ENI after MT.
•	Severe leukoaraiosis was not associated with END after MT.
•	Severe leukoaraiosis was associated with END in patients without sICH after MT.

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Abstract

Background and purpose

The aim of the study was to evaluate whether leukoaraiosis (LA) severity is associated with earlier neurological outcome in acute stroke patients undergoing mechanical thrombectomy.

Materials and methods

In this retrospective multicenter study, we evaluated 273 acute stroke patients treated with mechanical thrombectomy. LA severity was graded as 0–2 (absent-to-moderate) versus 3–4 (severe) according to the van Swieten scale. The main clinical outcome was the proportion of early neurological improvement and early neurological deterioration. Early neurological improvement was defined as a decrease of≥4 points on the NIHSS, or an NIHSS score of zero 24hours after baseline assessment. Early neurological deterioration was defined as an increase of≥4 points on the NIHSS 24hours after baseline assessment.

Results

There was a significantly lower early neurological improvement rate (17.1% versus 39.2%; P=0.006) and non-significantly higher early neurological deterioration rate (29.3% versus 17.7%; P=0.084) in patients with severe LA (sLA) compared with patients with absent-to-moderate LA. In multivariable analysis, sLA was inversely associated with early neurological improvement (OR, 0.31; 95% CI, 0.13–0.78; P=0.012). There was no significant association of sLA with early neurological deterioration. However, in patients without symptomatic intracranial hemorrhage, sLA was an independent predictor of early neurological deterioration (OR, 2.65; 95% CI, 1.09–6.45; P=0.032).

Conclusions

sLA is a significant negative predictor of early neurological improvement and is an independent predictor of early neurological deterioration in patients without symptomatic intracranial hemorrhage.

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Keywords : Stroke, Thrombectomy, Leukoaraiosis, Earlier neurological outcome

Abbreviations : ASPECTS, END, ENI, LA, mTICI, NIHSS, OTR, SBP, sICH, sLA