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Leukoaraiosis predicts a poor 90-day outcome after endovascular stroke therapy.

AbstractBACKGROUND AND PURPOSE:
Leukoaraiosis is a common finding among patients with ischemic stroke and has been associated with poor stroke outcomes. Our aim was to ascertain whether the severity of pre-existing leukoaraiosis is associated with outcome in patients with acute ischemic stroke who are treated with endovascular stroke therapy.
MATERIALS AND METHODS:
We retrospectively analyzed data from 129 consecutive, prospectively enrolled patients with stroke undergoing endovascular stroke therapy at a single tertiary care center between January 2006 and August 2013. Leukoaraiosis was assessed as supratentorial white matter hypoattenuation on admission head CT and graded as 0-2 (absent-to-moderate) versus 3-4 (severe) according to the van Swieten scale. We dichotomized the 90-day mRS into good (0-2 or return to baseline) versus poor (3-6) as the primary study outcome. Incremental multivariable logistic regression analyses were performed to identify independent predictors of a poor 90-day outcome.
RESULTS:
In all multivariable models, severe leukoaraiosis was independently (P < .05) associated with a poor outcome at 90 days (fully adjusted model: OR, 6.37; 95% CI, 1.83-12.18; P = .004). The independent association between leukoaraiosis and a poor outcome remained when the analysis was restricted to patients who were alive at discharge (n = 87, P < .05). Last, among patients who were alive at discharge, those with severe leukoaraiosis had significantly less frequent improvement on the mRS from discharge to 90 days compared with patients with absent-to-moderate leukoaraiosis (P = .034).
CONCLUSIONS:
The severity of pre-existing leukoaraiosis is independently associated with 90-day functional outcome in patients with stroke who underwent endovascular stroke therapy. These results highlight the need to further explore leukoaraiosis as a promising surrogate marker for poor outcome after endovascular stroke therapy to improve risk assessment, patient selection, and early prognostic accuracy.
AuthorsJ Zhang, A S Puri, M A Khan, R P Goddeau Jr, N Henninger
JournalAJNR. American journal of neuroradiology (AJNR Am J Neuroradiol) 2014 Nov-Dec Vol. 35 Issue 11 Pg. 2070-5 ISSN: 1936-959X [Electronic] United States
PMID24994827 (Publication Type: Journal Article)
Copyright© 2014 by American Journal of Neuroradiology.
Topics
  • Aged
  • Aged, 80 and over
  • Embolization, Therapeutic
  • Endovascular Procedures
  • Female
  • Humans
  • Leukoaraiosis (complications)
  • Male
  • Middle Aged
  • Prognosis
  • Recovery of Function
  • Retrospective Studies
  • Risk Assessment
  • Stroke (complications, diagnostic imaging, therapy)
  • Tomography, X-Ray Computed
  • Treatment Outcome

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