Brain Atrophy and Leukoaraiosis Correlate with Futile Stroke Thrombectomy

Kaginele, Pranita; Beer‐Furlan, André; Joshi, Krishna C.; Kadam, Geetanjalee; Achanaril, Anoop; Levy, Elad I.; Waqas, Muhammad; Siddiqui, Adnan H.; Rai, H; Snyder, Kenneth V.; Davies, Jason M; Crowley, R. Webster; Ouyang, Bo; Munich, Stephan A; Chen, Michael

doi:10.1016/j.jstrokecerebrovasdis.2021.105871

Cited by 14 publications

(13 citation statements)

References 13 publications

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“…Interestingly, we did not detect significant alterations in NIHSS or PC-ASPECTS at admission among different brain atrophy levels. This result agreed with previous findings from the Lauksio, Lee, and Pranita groups focusing on the roles of brain atrophy in outcome evaluation for patients with anterior circulation stroke (Lee et al, 2010;Lauksio et al, 2020;Kaginele et al, 2021). The effect of brain atrophy on prognosis might reflect a reduced ability of recovery after stroke rather than a blunting of the initial stroke severity or PC-ASPECTS (Lee et al, 2010;Schaapsmeerders et al, 2015).…”

Section: Discussionsupporting

confidence: 91%

Severe Brain Atrophy Predicts Poor Clinical Outcome After Endovascular Treatment of Acute Basilar Artery Occlusion: An Automated Volumetric Analysis of a Nationwide Registry

Liu

et al. 2021

Front. Aging Neurosci.

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Background: Brain atrophy globally reflects the effects of preexisting risk factors and biological aging on brain structures and normally predicts poor outcomes in anterior circulation stroke. However, comparing with these patients, acute basilar artery occlusion (ABAO) impairs infratentorial regions frequently and might benefit from brain atrophy due to the resulting residual space to reduce tissue compression and thus improve prognosis, which raises doubts that current understandings for prognostic roles of brain atrophy are also applicable for ABAO. Therefore, this study aims to evaluate brain atrophy automatically from CT images and investigates its impact on outcomes of ABAO following endovascular treatment (EVT).Methods: A total of 231 ABAO who underwent EVT from the BASILAR registry were enrolled. Brain atrophy was quantified as the ratio of brain parenchymal volume to cerebrospinal fluid volume on baseline CT. The primary outcome was the modified Rankin Scale (mRS) score at 3 months.Results: The frequency of favorable outcomes (90-day mRS ≤ 3) was significantly lower in the severe atrophy group (P = 0.014). Adjusted logistic models revealed that severe brain atrophy was significantly negatively associated with favorable outcome incidence (P = 0.006), with no relationship with either in-hospital or 90-day overall mortality (all P > 0.05). Adding a severe atrophy index into the baseline model obviously enhanced its discriminatory ability in predicting the outcome by obviously increasing areas under the receiver operating characteristic curve, net reclassification improvement algorithm, and integrated discrimination improvement algorithm values (all P < 0.05).Conclusion: Severe brain atrophy did not improve in-hospital or overall mortality but impaired the long-term recovery after EVT. This objective and automated marker has the potential to be incorporated into decision-support methods for treating ABAO.

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Section: Discussionsupporting

confidence: 91%

Severe Brain Atrophy Predicts Poor Clinical Outcome After Endovascular Treatment of Acute Basilar Artery Occlusion: An Automated Volumetric Analysis of a Nationwide Registry

Liu

et al. 2021

Front. Aging Neurosci.

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“…Several recent studies have found that EVT procedural-related factors (e.g., first-pass effect versus multiple-pass effect) and post-procedural complications are strong predictors of unfavorable functional outcome (24,25). In addition, radiological markers are emerging, CT-based texture, blood-brain barrier disruption, brain atrophy, and leukoaraiosis, CT perfusion-based cerebral perfusion parameters, and diffusion-weighted imaging (DWI)-based large deep white-matter lesions have demonstrated to predict prognosis after EVT (26)(27)(28)(29)(30). Moreover, blood-based biomarkers are also found to be predictive for unfavorable early (END) and long-term functional outcomes of EVTtreated AIS patients, including interleukin-6, NLR, N-terminal probrain natriuretic peptide, albumin, matrix metalloprotease-9, enascin-c, thioredoxin, ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13, and occludin, etc.…”

Section: Discussionmentioning

confidence: 99%

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Hao

Feng

et al. 2022

Front. Immunol.

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BackgroundNeuroinflammatory response contributes to early neurological deterioration (END) and unfavorable long-term functional outcome in patients with acute ischemic stroke (AIS) who recanalized successfully by endovascular thrombectomy (EVT), but there are no reliable biomarkers for their accurate prediction. Here, we sought to determine the temporal plasma profiles of the bioactive lipid mediators lipoxin A4 (LXA4), resolvin D1 (RvD1), and leukotriene B4 (LTB4) for their associations with clinical outcome.MethodsWe quantified levels of LXA4, RvD1, and LTB4 in blood samples retrospectively and longitudinally collected from consecutive AIS patients who underwent complete angiographic recanalization by EVT at admission (pre-EVT) and 24 hrs post-EVT. The primary outcome was unfavorable long-term functional outcome, defined as a 90-day modified Rankin Scale score of 3-6. Secondary outcome was END, defined as an increase in National Institutes of Health Stroke Scale (NIHSS) score ≥4 points at 24 hrs post-EVT.ResultsEighty-one consecutive AIS patients and 20 healthy subjects were recruited for this study. Plasma levels of LXA4, RvD1, and LTB4 were significantly increased in post-EVT samples from AIS patients, as compared to those of healthy controls. END occurred in 17 (20.99%) patients, and 38 (46.91%) had unfavorable 90-day functional outcome. Multiple logistic regression analyses demonstrated that post-EVT levels of LXA4 (adjusted odd ratio [OR] 0.992, 95% confidence interval [CI] 0.987-0.998), ΔLXA4 (adjusted OR 0.995, 95% CI 0.991-0.999), LTB4 (adjusted OR 1.003, 95% CI 1.001-1.005), ΔLTB4 (adjusted OR 1.004, 95% CI 1.002-1.006), and post-EVT LXA4/LTB4 (adjusted OR 0.023, 95% CI 0.001-0.433) and RvD1/LTB4 (adjusted OR 0.196, 95% CI 0.057-0.682) ratios independently predicted END, and post-EVT LXA4 levels (adjusted OR 0.995, 95% CI 0.992-0.999), ΔLXA4 levels (adjusted OR 0.996, 95% CI 0.993-0.999), and post-EVT LXA4/LTB4 ratio (adjusted OR 0.285, 95% CI 0.096-0.845) independently predicted unfavorable 90-day functional outcome. These were validated using receiver operating characteristic curve analyses.ConclusionsPlasma lipid mediators measured 24 hrs post-EVT were independent predictors for early and long-term outcomes. Further studies are needed to determine their causal-effect relationship, and whether the imbalance between anti-inflammatory/pro-resolving and pro-inflammatory lipid mediators could be a potential adjunct therapeutic target.

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“…Baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) from the non-contrast CT (NCCT) and CT angiography source images (CTA-SI) are useful in predicting futile recanalization and could be valuable tools for treatment decisions regarding revascularization therapies (13). Similarly, studies employing NCCT to determine the risk factors in AIS patients treated with mechanical thrombectomy have revealed that the presence of leukoaraiosis and brain atrophy is associated with poor outcome in recanalized patients (14,15). Furthermore, another study applying diffusion-weighted magnetic resonance imaging (DWI) to predict futile recanalization has demonstrated that patients with large preintervention DWI lesions in the deep white matter may be poor candidates for endovascular therapy (6).…”

Section: Introductionmentioning

confidence: 99%

Multiple-Factor Analyses of Futile Recanalization in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

et al. 2021

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Background and Purpose: Acute ischemic stroke (AIS) is a serious threat to the life and health of middle-aged and elderly people. Mechanical thrombectomy offers the advantages of rapid recanalization, but the response of patients to this treatment varies greatly. This study investigated the risk factors for futile recanalization in AIS patients after thrombectomy through multivariate analyses.Methods: A retrospective study was conducted in AIS patients with anterior circulation occlusion from a derivation cohort and a validation cohort who underwent thrombectomy and reperfusion defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. Using the modified Rankin Scale (mRS) at 90 days after the operation, the patients were divided into two groups, the meaningful recanalization group (mRS ≤ 2), and the futile recanalization group (mRS > 2). Multivariate logistic regression analyses were performed, and the receiver operating characteristic (ROC) curve was used to construct a risk prediction model for futile recanalization. The performance of prediction model was evaluated on the validation cohort.Results: A total of 140 patients in the derivation cohort were enrolled, 46 patients in the meaningful recanalization group and 94 patients in the futile recanalization group. The two groups were significantly different in age, preoperative National Institute of Health Stroke Scale (NIHSS) score, and collateral circulation ASITN/SIR grade (P < 0.05). In multivariate regression analyses, patients' age ≥ 71, NIHSS ≥ 12, and ASITN/SIR ≤ 3 were risk factors for futile recanalization. Hence, an ANA (Age-NIHSS-ASITN/SIR) score scale consisting of age, NIHSS score, and ASITN/SIR grade factors can effectively predict the risk for futile recanalization (area under curve 0.75, 95% CI 0.67–0.83, specificity 67.4%, and sensitivity 73.4%). The proportion of patients with futile recanalization in ANA groups 0, 1, 2, and 3 were 21.05, 56.76, 79.03, and 90.91%, respectively. Furthermore, ANA score scale had also a good performance for predicting futile recanalization on the validation cohort.Conclusions: Old age, high baseline NIHSS, and poor collateral circulation are risk factors for futile recanalization in AIS patients treated with thrombectomy. An ANA score that considers age, NIHSS, and collateral ASITN/SIR can effectively predict the risk for futile recanalization. Further studies with a larger sample size are needed to validate the prognostic value of this combined score for futile recanalization.

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Brain Atrophy and Leukoaraiosis Correlate with Futile Stroke Thrombectomy

Cited by 14 publications

References 13 publications

Severe Brain Atrophy Predicts Poor Clinical Outcome After Endovascular Treatment of Acute Basilar Artery Occlusion: An Automated Volumetric Analysis of a Nationwide Registry

Severe Brain Atrophy Predicts Poor Clinical Outcome After Endovascular Treatment of Acute Basilar Artery Occlusion: An Automated Volumetric Analysis of a Nationwide Registry

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Multiple-Factor Analyses of Futile Recanalization in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

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