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Erschienen in: Neurological Sciences 3/2019

01.03.2019 | Original Article

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

verfasst von: Yukai Liu, Pengyu Gong, Huanhuan Sun, Shuting Zhang, Junshan Zhou, Yingdong Zhang

Erschienen in: Neurological Sciences | Ausgabe 3/2019

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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.
Literatur
1.
Zurück zum Zitat 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):3020–3035CrossRefPubMed 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):3020–3035CrossRefPubMed
2.
Zurück zum Zitat 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–e110CrossRef 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–e110CrossRef
3.
Zurück zum Zitat 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):11–21CrossRefPubMed 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):11–21CrossRefPubMed
4.
Zurück zum Zitat 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):1723–1731CrossRef 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):1723–1731CrossRef
5.
Zurück zum Zitat 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 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.
Zurück zum Zitat Prins ND, Scheltens P (2015) White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol 11(3):157–165CrossRefPubMed Prins ND, Scheltens P (2015) White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol 11(3):157–165CrossRefPubMed
7.
Zurück zum Zitat Streifler J, Maillard P (2017) Thrombolysis for acute ischemic stroke in patients with leukoaraiosis: caution needed. Neurology 88(7):612–613CrossRefPubMed Streifler J, Maillard P (2017) Thrombolysis for acute ischemic stroke in patients with leukoaraiosis: caution needed. Neurology 88(7):612–613CrossRefPubMed
8.
Zurück zum Zitat 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):158–170CrossRefPubMed 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):158–170CrossRefPubMed
9.
Zurück zum Zitat 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):638–645CrossRefPubMedPubMedCentral 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):638–645CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat 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):1009–1018CrossRef 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):1009–1018CrossRef
11.
Zurück zum Zitat 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):961–967CrossRefPubMed 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):961–967CrossRefPubMed
12.
Zurück zum Zitat 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):2463–2466CrossRefPubMed 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):2463–2466CrossRefPubMed
13.
14.
Zurück zum Zitat 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):2364–2372CrossRefPubMedPubMedCentral 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):2364–2372CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat 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):62–67CrossRefPubMed 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):62–67CrossRefPubMed
16.
Zurück zum Zitat 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):3141–3155CrossRefPubMedPubMedCentral 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):3141–3155CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat 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):1393–1397CrossRefPubMed 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):1393–1397CrossRefPubMed
18.
Zurück zum Zitat 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 24:326–337CrossRefPubMedPubMedCentral 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 24:326–337CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat 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):55–60CrossRefPubMedPubMedCentral 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):55–60CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat 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 378:94–99CrossRefPubMed 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 378:94–99CrossRefPubMed
Metadaten
Titel
Leukoaraiosis is associated with poor outcomes after successful recanalization for large vessel occlusion stroke
verfasst von
Yukai Liu
Pengyu Gong
Huanhuan Sun
Shuting Zhang
Junshan Zhou
Yingdong Zhang
Publikationsdatum
01.03.2019
Verlag
Springer International Publishing
Erschienen in
Neurological Sciences / Ausgabe 3/2019
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-018-3698-2

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