Leukoaraiosis and Sex Predict the Hyperacute Ischemic Core Volume

Abstract

Background and Purpose Leukoaraiosis (LA) and male sex have been associated with decreased cerebrovascular reactivity, which potentially adversely affects tissue viability in acute stroke. Therefore, we aimed to elucidate the contribution of LA-severity and sex to the extent of the hyperacute ischemic core volume following intracranial large artery occlusion (ILAO). Methods We analyzed data from 87 patients with acute ILAO who had acute multimodal CT-imaging. LA-severity was assessed using the van Swieten scale on non-contrast CT. CT-perfusion (CTP) data were analyzed using automatic calculation of the mean transit time (MTT) and hyperacute cerebral blood volume (CBV) defects. Multivariate linear and logistic regression analyses were used to identify independent predictors of the hyperacute infarct-volume. Results Severe LA (VSS 3–4; OR 43.22, 95%-CI 6.26–298.42, p<0.001) and male sex (OR 7.52, 95%-CI 1.38–40.86, p=0.020) were independently associated with a hyperacute CBV-lesion >25 mL on multivariate logistic regression analysis. Multivariate linear regression analysis confirmed the association between severe LA (p<0.001) and male sex (p=0.01) with larger CBV lesions. There was no significant difference in the absolute or relative MTT-lesion volumes when stratified by LA severity or sex. Women had significantly smaller CBV-lesion volumes compared to men (p=0.036). Conclusions Severe LA and male sex are associated with larger infarct cores, which adds to the notion that sex and LA alter the brain’s intrinsic susceptibility to acute cerebral ischemia. Future, larger studies are needed to confirm our observation that women have smaller core volumes and its significance.

Integrity of normal-appearing white matter and functional outcomes after acute ischemic stroke

“…However, both NIHSS score and small vessel (TOAST) stroke subtype were independently associated with acute infarct volume, consistent with prior reports. 1,22 Interestingly, small vessel stroke subtype was not associated with mRS score, which is likely a consequence of insufficient power of this portion of the analysis (n 5 29 patients with stroke attributed to small vessel occlusion), or alternatively, it is suggestive of a complex relationship between clinical outcome and stroke subtype, which may involve additional variables such as interaction with stroke lesion topography. 18 Overall, the role of WM microstructural integrity in the acute ischemic tissue outcomes warrants further investigation.…”

“…The role of white matter hyperintensity (WMH), or leukoaraiosis, in outcomes after acute ischemic stroke (AIS) is increasingly recognized through its link to larger acute infarct lesions, 1 likelihood of infarct expansion, 2 and association with worse functional poststroke outcomes. [3][4][5] However, a growing body of evidence suggests that macrostructural white matter (WM) disease burden, quantified as WMH on T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI, may not adequately reflect the total extent of WM injury and that microstructural injury to normal-appearing WM (NAWM) can be associated with clinical phenotypes.…”

Leukoaraiosis Predicts a Poor 90-Day Outcome after Endovascular Stroke Therapy

“…Of note, 42 (33%) studied subjects have been included in prior investigations. 8,13 We adhered to the STrengthening the Reporting of OBservational studies in Epidemiology guidelines (www.strobe-statement.org). All patients underwent head CT and CTA at admission.…”

“…All patients underwent head CT and CTA at admission. Demographics, NIHSS scores, laboratory data, comorbidities, preadmission medications, and stroke etiology (by using the Trial of Org 10172 in Acute Stroke Treatment classification), 8,13 after completion of diagnostic evaluation, were collected on all patients. mRS scores were assessed at the time of presentation (preadmission mRS), discharge, and at 90 days by a stroke-trained physician or stroke study nurse, certified in mRS. 8 When the mRS was unavailable, the same observers reconstructed the score from the case description, according to the mRS criteria.…”

“…Variable window width and center-level settings were used for optimal ischemic hypoattenuation detection with CT and CTA. 8,13 Leukoaraiosis was retrospectively defined by 2 readers (N.H. and J.Z.) as supratentorial white matter hypoattenuation on admission noncontrast head CT according to the STandards for ReportIng Vascular changes on nEuroimaging criteria, 14 and it was graded on a 5-point van Swieten scale as previously described in detail (On-line Fig 1).…”