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

Zhang, Jingyan; Puri, Ajit S; Khan, Muhammad Arsalan; Goddeau, Richard P.; Henninger, Nils

doi:10.3174/ajnr.a4029

Cited by 45 publications

(44 citation statements)

References 28 publications

(63 reference statements)

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“…[7][8][9] However, whether age, or age-related phenomena, affect the hemispheric lateralization of the NIHSS deficit is presently unclear. In this respect, leukoaraiosis is of particular interest because it commonly present among the elderly, 10,11 worsens functional deficit severity after ischemic stroke, 12,13 and decreases white matter tract and functional network integrity. 14,15 Accordingly, age-related leukoaraiosis could represent an easily accessible imaging marker that affects the association between deficit severity and side of infarction as assessed by the NIHSS.…”

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confidence: 99%

Impact of Leukoaraiosis Burden on Hemispheric Lateralization of the National Institutes of Health Stroke Scale Deficit in Acute Ischemic Stroke

Helenius

Goddeau

Moonis

et al. 2016

Stroke

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BACKGROUND AND PURPOSE: The National Institutes of Health Stroke Scale (NIHSS) awards higher deficit scores for infarcts in the dominant hemisphere when compared with otherwise similar infarcts in the nondominant hemisphere. This has been shown to adversely affect stroke recognition, therapeutic decisions, and outcome. However, factors modifying the association between infarct side and deficit severity are incompletely understood. Thus, we sought to determine whether age and age-related leukoaraiosis alter the relation between NIHSS deficit score and the side and volume of infarction. METHODS: We studied 238 patients with supratentorial, nonlacunar ischemic infarcts prospectively included in our stroke registry between January 2013 and January 2014. NIHSS deficit severity was assessed at the time of presentation. Infarct volumes were assessed by manual planimetry on diffusion-weighted imaging. Leukoaraiosis burden was graded on fluid-attenuated inversion recovery images according to the Fazekas scale and dichotomized to none-to-mild (0-2) versus severe (3-6). Multivariable linear regression with backward elimination was used to identify independent predictors of the admission NIHSS. RESULTS: Left-hemispheric infarction (P \u3c 0.001), severe leukoaraiosis (P=0.001), their interaction term (P=0.005), infarct volume (P \u3c 0.001), and sex (P=0.013) were independently associated with the NIHSS deficit. Analysis of the individual NIHSS components showed that severe leukoaraiosis was associated with an increase of the lateralizing components of the NIHSS in patients with right-hemispheric infarction (P\u3c0.05). CONCLUSIONS: Severe leukoaraiosis substantially attenuates the classic hemispheric lateralization of the NIHSS deficit by relating to greater NIHSS scores of components that are typically assigned to left hemisphere function

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confidence: 99%

Impact of Leukoaraiosis Burden on Hemispheric Lateralization of the National Institutes of Health Stroke Scale Deficit in Acute Ischemic Stroke

Helenius

Goddeau

Moonis

et al. 2016

Stroke

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“…However, we did not find the relationship between severity of LA and the level of reperfusion. A couple of previous studies have adjusted recanalization status as covariates when investigating the independent relationship between the severity of LA and the size of infarct lesion or clinical outcome [4,14]. But substantial evidences demonstrated that reperfusion outperformed recanalization in predicting infarct growth and outcomes after AIS [18].…”

Section: Discussionmentioning

confidence: 97%

“…Actually, several studies have associated the burden of LA with poor outcome after AIS, even if they have received recanalization therapy (IVT or endovascular thrombectomy) [14,15], which might indicate that improving reperfusion level could not adequately reverse the unfavorable destination for patients with severe LA. However, it is worth noting that this situation should not discourage any efforts to gain reperfusion for these patients, because both severity of LA and reperfusion were the two major independent predictors of clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Actually, for AIS patients with severe LA, the clinical outcome is still discouraging even after reperfusion therapy [14,15]. If the burden of LA truly negates the beneficial effects of reperfusion therapy via improving reperfusion, current practice of intravenous thrombolysis (IVT) or endovascular thrombectomy may be seriously re-evaluated for patients with severe LA.…”

Section: Introductionmentioning

confidence: 99%

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Association between Leukoaraiosis and Poor Outcome is not due to Reperfusion Inefficiency after Intravenous Thrombolysis

Zhong

Yan

Zhang

et al. 2016

Transl. Stroke Res.

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Leukoaraiosis (LA) is associated with structural and functional cerebrovascular impairment, which may compromise the capacity of ischemic tissue to maximize reperfusion after intravenous thrombolysis (IVT). We aimed to determine whether severe LA is correlated with reperfusion inefficiency, which contributes to infarct growth and poor functional outcome. We analyzed data from our consecutive acute ischemic stroke (AIS) patients who had acquired baseline and 24-h follow-up diffusion- and perfusion-weighted imaging. Reperfusion was defined as reduction of ≥70 % of hypoperfusion lesion at 24 h from baseline. Severe LA was defined as Fazekas score 2 or 3 on FLAIR images. We investigated the relationship between severity of LA and reperfusion status. Multivariate statistical analysis was carried out for modeling the independent predictors of reperfusion, infarct growth, and functional outcome. Finally, 79 patients were included, among them 30 (37.97 %) had severe LA. Reperfusion was observed in 41 (51.89 %) patients, the proportion of reperfusion was very similar in patients with and without severe LA (53.33 vs 51.02 %, p = 1.000). Large artery occlusion was the only independent unfavorable predictor for reperfusion (OR = 0.202, 95 % confidence interval, 0.060-0.673; p = 0.014). Multiple linear regression analysis revealed that severe LA was independently associated with infarct growth (standardized coefficients = 0.191, p = 0.040). Severe LA was also an independent predictor of poor outcome (mRS ≥ 3) (OR = 4.004, 95 % confidence interval, 1.267-12.656, p = 0.018) after adjusting for reperfusion and baseline severity of stroke. Severe LA was associated with infarct growth and poor outcome independent of reperfusion status, which may expand the notion that LA contributes the intrinsic vulnerability of brain tissue to acute ischemic insults. The burden of LA may not serve as an imaging indicator of reperfusion inefficiency after IVT for AIS patients.

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“…Among patients presenting in the hyperacute period, there was no difference in the time to presentation or the severity in the admission NIHSS between patients with mild versus severe leukoaraiosis (P>0.05, each). 3 Furthermore, the volume of tissue at risk for infarction as assessed by computed tomographic perfusion was similar across leukoaraiosis severity grades. 4 Second, we did not quantify the degree of brain atrophy, which has been shown to correlate with cognitive impairment.…”

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confidence: 91%

Response to Letter Regarding Article, “Leukoaraiosis Burden Significantly Modulates the Association Between Infarct Volume and National Institutes of Health Stroke Scale in Ischemic Stroke”

Helenius

Henninger

2015

Stroke

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

Cited by 45 publications

References 28 publications

Impact of Leukoaraiosis Burden on Hemispheric Lateralization of the National Institutes of Health Stroke Scale Deficit in Acute Ischemic Stroke

Impact of Leukoaraiosis Burden on Hemispheric Lateralization of the National Institutes of Health Stroke Scale Deficit in Acute Ischemic Stroke

Association between Leukoaraiosis and Poor Outcome is not due to Reperfusion Inefficiency after Intravenous Thrombolysis

Response to Letter Regarding Article, “Leukoaraiosis Burden Significantly Modulates the Association Between Infarct Volume and National Institutes of Health Stroke Scale in Ischemic Stroke”

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