Severe Leukoaraiosis Is Associated with Poor Outcome after Successful Recanalization of M1 Middle Cerebral Artery Occlusion Strokes

Mutzenbach, Johannes Sebastian; Müller-Thies-Broussalis, Erasmia; Killer‐Oberpfalzer, Monika; Griessenauer, Christoph J.; Hecker, Constantin; Moscote-Salazar, Luis Rafael; Paradaiser, Pia; Pikija, Slaven

doi:10.1159/000508209

Cited by 13 publications

(10 citation statements)

References 31 publications

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“…The final meta‐analysis of the association of baseline severity of leukoaraiosis with the functional outcome at 90 days post‐stroke included 11 studies with a total of 4438 patients 3,27‐36 2).…”

Section: Resultsmentioning

confidence: 99%

Leukoaraiosis severity and post‐reperfusion outcomes in acute ischaemic stroke: A meta‐analysis

Rastogi

Weissert

Bhaskar

2021

Acta Neuro Scandinavica

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Objectives Severity of leukoaraiosis may mediate outcomes after reperfusion therapy in acute ischaemic stroke (AIS) patients. However, the level of the association remains poorly understood. We performed a meta‐analysis to investigate the impact of leukoaraiosis severity on functional outcome, survival, haemorrhagic complications, and procedural success in AIS patients treated with intravenous thrombolysis and/or endovascular thrombectomy. Materials and Methods PubMed, EMBASE and the Cochrane library were searched for studies on leukoaraiosis in AIS receiving reperfusion therapy. A random‐effects meta‐analysis was conducted for post‐reperfusion outcomes in AIS patients with absent‐to‐mild leukoaraiosis and moderate‐to‐severe leukoaraiosis. The strength of association between moderate‐to‐severe leukoaraiosis and poor outcomes was quantified using odds ratios (OR). Results A total of 15 eligible studies involving 6460 patients (1451 with moderate‐to‐severe leukoaraiosis and 5009 with absent‐to‐mild leukoaraiosis) were included in the meta‐analysis. Moderate‐to‐severe leukoaraiosis was significantly associated with poor 90‐day functional outcome (OR 3.16; 95% confidence interval (CI) 2.69–3.72; p < .0001), 90‐day mortality (OR 3.11; 95% CI 2.27–4.26; p < .0001) and increased risk of symptomatic intracerebral haemorrhage (OR 1.69; 95% CI 1.24–2.32; p = .001) after reperfusion therapy. Overall, no significant association of leukoaraiosis severity with haemorrhagic transformation (HT) and angiographic recanalization status were observed. However, subgroup analysis revealed a significant association of WML severity with HT in patients receiving EVT. Conclusion Leukoaraiosis is a useful prognostic biomarker in AIS. Patients with moderate‐to‐severe leukoaraiosis on baseline imaging are likely to have worse clinical and safety outcomes after reperfusion therapy.

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Section: Resultsmentioning

confidence: 99%

Leukoaraiosis severity and post‐reperfusion outcomes in acute ischaemic stroke: A meta‐analysis

Rastogi

Weissert

Bhaskar

2021

Acta Neuro Scandinavica

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“…Of the 5,277 records assessed with titles and abstracts, the full texts of 231 articles were reviewed. Overall, 20 articles published between 2012 and 2020 met our inclusion criteria and were finally included in this meta-analysis (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The study characteristics are summarized in Table 1.…”

Section: Study Characteristics and Qualitative Assessmentmentioning

confidence: 99%

Small Vessel Disease Burden and Outcomes of Mechanical Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis

Wang

Yuan

et al. 2021

Front. Neurol.

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Background: Cerebral small vessel disease (SVD) is prevalent in the population, especially among elderly individuals. Substantial uncertainties remain about the clinical relevance of SVD with outcomes of mechanical thrombectomy (MT) in acute ischemic stroke (AIS).Objectives: This systematic review and meta-analysis was performed to evaluate the association between SVD and clinical outcomes in patients with AIS undergoing MT.Methods: We systematically searched the Medline, Embase, and Cochrane databases for relevant clinical studies. The exposure of SVD mainly included leukoaraiosis, cerebral microbleeds (CMBs), and lacunes. The pooled OR was used to calculate the association between each subtype of SVD and outcomes of MT. The primary outcome was poor functional outcome, which was defined as a modified Rankin Scale score (mRS) ≥3 at 90 days after MT. The secondary outcomes included mortality at 90 days, in-hospital mortality, intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), successful recanalization and futile recanalization (FR), early neurological improvement, and early neurological deterioration (END) after MT.Results: Overall, 20 studies with 5,189 patients with AIS undergoing MT were included. High leukoaraiosis burden (HLB) at baseline was associated with increased risks of poor functional outcome at 90 days (OR 2.70, 95% CI 2.01–3.63; p < 0.001; 10 studies; n = 2,004), in-hospital mortality (OR 4.06, 95% CI 1.48–11.13; p = 0.006; 2 studies; n = 314), FR (OR 5.00, 95% CI 2.86–8.73; p < 0.001; 3 studies; n = 493), and END (OR 2.65, 95% CI 1.09–6.45; 1 study; n = 273) after MT. HLB (VSS 3–4 or FS ≥ 2) at baseline was not associated with mortality at 90 days, ICH, or sICH after MT. CMBs at baseline were found to be associated with increased risks of poor functional outcome at 90 days (OR 1.84, 95% CI 1.17–2.90; p = 0.008; 2 studies; n = 1,924) after MT. We found no association between the presence of lacunes and poor functional outcome at 90 days after MT.Conclusions: In patients with AIS undergoing MT, HLB and CMBs were associated with increased risks of unfavorable outcomes after MT.

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“…Unlike patients with absent-to-moderate LA burden, stroke survivors with severe LA were accompanied by a rather diminished chance of a favorable clinical outcome after MT, thus establishing LA severity as a significant MT efficiency indicator. In line with the aforementioned studies’ results, Mutzenbach et al [ 38 ], having examined 209 patients with AIS treated with MT, showed that approximately only one-fifth of individuals with severe LA achieve a good functional status at 3 months poststroke despite successful revascularization, thus highlighting the highly predictive value of pre-existing LA regarding MT clinical outcome and the role of severe LA as an independent risk factor for poor recovery after MT. Interestingly, the degree of white matter abnormalities was demonstrated to be positively associated with age, a linear relationship that appears to be of key importance within an aging population with higher odds of stroke occurrence and MT implementation.…”

Section: Discussionmentioning

confidence: 66%

Elucidating the Role of Baseline Leukoaraiosis on Forecasting Clinical Outcome of Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy

Karatzetzou

Tsiptsios

Sousanidou

et al. 2022

Neurology International

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Stroke stands as a major cause of death and disability with increasing prevalence. The absence of clinical improvement after either intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) represents a frequent concern in the setting of acute ischemic stroke (AIS). In an attempt to optimize overall stroke management, it is clinically valuable to provide important insight into functional outcomes after reperfusion therapy among patients presenting with AIS. The aim of the present review is to explore the predictive value of leukoaraiosis (LA) in terms of clinical response to revascularization poststroke. A literature research of two databases (MEDLINE and Scopus) was conducted in order to trace all relevant studies published between 1 January 2012 and 1 November 2022 that focused on the potential utility of LA severity regarding reperfusion status and clinical outcome after revascularization. A total of 37 articles have been traced and included in this review. LA burden assessment is indicative of functional outcome post-intervention and may be associated with hemorrhagic events’ incidence among stroke individuals. Nevertheless, LA may not solely guide decision-making about treatment strategy poststroke. Overall, the evaluation of LA upon admission seems to have interesting prognostic potential and may substantially enhance individualized stroke care.

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Severe Leukoaraiosis Is Associated with Poor Outcome after Successful Recanalization of M1 Middle Cerebral Artery Occlusion Strokes

Cited by 13 publications

References 31 publications

Leukoaraiosis severity and post‐reperfusion outcomes in acute ischaemic stroke: A meta‐analysis

Leukoaraiosis severity and post‐reperfusion outcomes in acute ischaemic stroke: A meta‐analysis

Small Vessel Disease Burden and Outcomes of Mechanical Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis

Elucidating the Role of Baseline Leukoaraiosis on Forecasting Clinical Outcome of Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy

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