Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke

Griessenauer, Christoph J.; McPherson, David D.; Berger, Andrea; Cuiper, Ping; Sofoluke, Nelson; Adams, Matthew D.; Kunaprayoon, Saran; Zand, Ramin; Li, Jiang; Abedi, Vida; Goren, Oded; Schirmer, Clemens M.; Donahue, Kathleen; Nardin, Marco; Giese, Anne Karin; Schirmer, Markus D.; Rost, Natalia S.; Hendrix, Philipp

doi:10.1159/000509071

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…The presence of severe PVWMLs and DWMLs was independently associated with an unfavorable short-term functional outcome in stroke patients with ATF, which was in line with reports regarding outcomes of general stroke patients with WMLs ( 34 , 35 ). Recovery from stroke involves widespread neural network to compensate for the damaged neural connections ( 36 ).…”

Section: Discussionsupporting

confidence: 90%

Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

et al. 2021

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Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF.Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF.Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25–0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21–0.79 for severe DWMLs].Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.

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Section: Discussionsupporting

confidence: 90%

Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

et al. 2021

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“…6,7 However, in patients with severe deficits, caused by large vessel occlusion, previous studies have questioned such observations as they did not find a clear relationship between WMH and revascularizing treatment gains and outcome. 23,24 In agreement with these data, we did not detect significant correlations between the established WMH volume and mRS at follow-up in our cohort, neither for total WMH, nor for pWMH and dWMH (Supplementary Tables 2 and 3). In contrast, we found that the degree of network disconnectivity affecting specific cortical and subcortical brain regions associated with pWMH was correlated with functional outcome.…”

Section: Discussionsupporting

confidence: 89%

Localized network damage related to white matter hyperintensities is linked to worse outcome after severe stroke

Olszówka,

Frey,

Frontzkowski

et al. 2024

Preprint

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White matter hyperintensities of presumed vascular origin (WMH), a manifestation of cerebral small vessel disease, are associated with various clinical sequelae. In stroke patients, total WMH burden is linked to recurrent cerebrovascular events and worse clinical outcome. As WMH also affect the integrity of structural large-scale brain networks, we hypothesize that the extent of WMH-related network damage carries relevant information to explain outcome variability in addition to global WMH volume. Clinical and structural brain imaging data of 33 severely affected acute stroke patients were analysed from two independent cohorts. Imaging data were acquired within the first two weeks after stroke. WMH-related localized and global network damage was derived, involving cortical and subcortical brain regions of an extended motor network. Using ordinal logistic regression analyses, network damage was associated with functional outcome, operationalized by the modified Rankin Scale, at follow-up after three to six months. WMH were linked to a significant disconnection of multiple ipsilesional and contralesional cortical and subcortical brain regions. Global as well as localized periventricular WMH-related network damage affecting distinct brain regions of both hemispheres, including the precentral and the inferior frontal gyrus, areas of the dorsolateral prefrontal cortex, the insula, and multiple subcortical nuclei, was independently associated with a worse outcome after adjustment for baseline symptom burden, age, brain infarct volume and total WMH volume. Total and deep WMH-related network disturbances did not show similar associations. This study shows that periventricular WMH-related network damage affecting specific brain regions of the frontal and insular lobe, and subcortical nuclei is linked to functional outcome in acute stroke patients. This supports the evolving concept of structural brain reserve and underscores the potential significance of pre-existing WMH-related network damage as a crucial factor in comprehending outcome variability after severe stroke.

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“…Researchers propose that based on these results, preventing the WMH risk factors, such as age, male sex, hypertension, history of ischemic stroke and atrial fibrillation may lower the risk of severe stroke and lead to a better prognosis in symptomatic CAS patients. Griessenauer and colleagues [ 70 ] compared the impact of WMH grading on 3-month functional outcome of large vessel occlusion (LVO) vs. non-LVO strokes. In both groups, advanced age, dyslipidemia, anemia, smoking, anemia, COPD, and a family history of stroke, NIHSS scale on admission and increasing WMH volume up to 4 mL were significantly associated with unfavorable functional outcome at 90 days.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Utility of Leukoaraiosis as a Prognostic Indicator in Ischemic Stroke Patients

Christidi

Tsiptsios

Sousanidou

et al. 2022

Neurology International

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Stroke constitutes a major cause of functional disability with increasing prevalence among adult individuals. Thus, it is of great importance for both clinicians and stroke survivors to be provided with a timely and accurate prognostication of functional outcome. A great number of biomarkers capable of yielding useful information regarding stroke patients’ recovery propensity have been evaluated so far with leukoaraiosis being among them. Literature research of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 25 June 2022 that dealt with the clinical utility of a current leukoaraiosis as a prognostic indicator following stroke. Only full-text articles published in English language were included. Forty-nine articles have been traced and are included in the present review. Our findings highlight the prognostic value of leukoaraiosis in an acute stroke setting. The assessment of leukoaraiosis with visual rating scales in CT/MRI imaging appears to be able to reliably provide important insight into the recovery potential of stroke survivors, thus significantly enhancing stroke management. Yielding additional information regarding both short- and long-term functional outcome, motor recovery capacity, hemorrhagic transformation, as well as early neurological deterioration following stroke, leukoaraiosis may serve as a valuable prognostic marker poststroke. Thus, leukoaraiosis represents a powerful prognostic tool, the clinical implementation of which is expected to significantly facilitate the individualized management of stroke patients.

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Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke

Cited by 11 publications

References 22 publications

Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

Localized network damage related to white matter hyperintensities is linked to worse outcome after severe stroke

The Clinical Utility of Leukoaraiosis as a Prognostic Indicator in Ischemic Stroke Patients

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