Leukoaraiosis Predicts Cortical Infarct Volume After Distal Middle Cerebral Artery Occlusion

Abstract

The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl

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

“…Leukoaraiosis may represent a viable biomarker because it can be determined by standard neuroimaging and has been consistently shown to predict a higher risk for poor poststroke outcome. [5][6][7][8]15,18 How leukoaraiosis contributes to worse poststroke outcomes Functional improvement of patients who were alive at the time of discharge (n ϭ 87) according to leukoaraiosis severity (unadjusted). Compared with patients with absent-to-moderate leukoaraiosis, patients with severe leukoaraiosis are significantly less likely to have any improvement on the mRS from discharge to 90 days (50% versus 79% of surviving patients [21% versus 59% of all patients, respectively]; P ϭ .034; darker shades indicate less improvement).…”

“…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). 15 Disagreements in readings were resolved by consensus. In the present study, leukoaraiosis was separately assessed in each hemisphere, but only the score from the nonischemic hemisphere was considered after unblinding.…”

“…To avoid classification bias and to minimize interrater variability, 8 Last, to assess the potential association among leukoaraiosis, infarct volume, and outcome, manual lesion assessment 13,15 was conducted in patients who had follow-up imaging within 7 days of stroke onset (MR imaging: n ϭ 43; CT: n ϭ 25), allowing reliable measurements.…”

“…21 Indeed, we and others have previously shown that leukoaraiosis severity is associated with a larger ischemic core, mismatch lost, and final infarct volume, supporting this hypothesis. 13,15,22 Indeed, subgroup analyses in patients with available follow-up imaging indicated that worse leukoaraiosis independently predicted larger infarct volumes. However, because infarct volumes could not be measured in all patients, additional studies are required to confirm the association among leukoaraiosis, infarct volume, and outcome.…”

Leukoaraiosis Burden Significantly Modulates the Association Between Infarct Volume and National Institutes of Health Stroke Scale in Ischemic Stroke

“…Importantly, leukoaraiosis severity has been associated with the size of the acute ischemic tissue damage and degree of infarct expansion, as well as initial NIHSS deficit severity. [2][3][4] In addition, leukoaraiosis-related loss of white matter tract organization with damage to intra-and interhemispheric white matter pathways could result in reduced functional network integrity. [5][6][7][8][9] This may impair brain plasticity and compensatory mechanisms for acute deficits such that even small strokes could result in relatively large functional deficits.…”