Leukoaraiosis Predicts Parenchymal Hematoma After Mechanical Thrombectomy in Acute Ischemic Stroke

The purpose of this study was to determine whether leukoaraiosis (LA) predicts hemorrhagic transformation and poor outcome in patients with acute ischemic stroke treated by mechanical thrombectomy. We retrospectively analyzed patients with anterior circulation stroke treated with Merci devices and i...

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Bibliographic Details
Published in:	Stroke (1970) Vol. 43; no. 7; pp. 1806 - 1811
Main Authors:	SHI, Zhong-Song, LOH, Yince, SALAMON, Noriko, VILLABLANCE, J. Pablo, ALI, Latisha K, OVBIAGELE, Bruce, KIM, Doojin, VINUELA, Fernando, DUCKWILER, Gary R, LIEBESKIND, David S, SAVER, Jeffrey L, GONZALEZ, Nestor R, TATESHIMA, Satoshi, JAHAN, Reza, LEI FENG, VESPA, Paul M, STARKMAN, Sidney
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins 01-07-2012
Subjects:	Adult Aged Aged, 80 and over Biological and medical sciences Brain Ischemia - epidemiology Brain Ischemia - therapy Cohort Studies Female Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Hematoma, Subdural, Chronic - epidemiology Hematoma, Subdural, Chronic - therapy Humans Leukoaraiosis - epidemiology Leukoaraiosis - therapy Male Mechanical Thrombolysis - adverse effects Medical sciences Middle Aged Nervous system (semeiology, syndromes) Neurology Predictive Value of Tests Prospective Studies Retrospective Studies Stroke - epidemiology Stroke - therapy Vascular diseases and vascular malformations of the nervous system mechanical thrombectomy Cerebral infarction Stroke Nervous system diseases Prognosis Cardiovascular disease Cerebral disorder Vascular disease intracerebral hemorrhage acute stroke outcomes Cerebral hemorrhage Central nervous system disease Hematoma Brain ischemia Leucoaraïosis leukoaraiosis Cerebrovascular disease
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Summary:	The purpose of this study was to determine whether leukoaraiosis (LA) predicts hemorrhagic transformation and poor outcome in patients with acute ischemic stroke treated by mechanical thrombectomy. We retrospectively analyzed patients with anterior circulation stroke treated with Merci devices and identified LA in the deep white matter (DWM) and periventricular white matter on the preintervention MR images. We dichotomized patients into those with moderate or severe LA in the DWM versus those without. Hemorrhage rates and outcomes were evaluated between 2 groups. We analyzed the association of moderate or severe LA with hemorrhagic transformation and poor outcome. Twenty-six of 105 patients had moderate or severe LA in the DWM. Patients with moderate or severe LA in the DWM were older, had more severe neurological deficits and worse outcome, had higher rates of hemorrhagic transformation and parenchymal hematoma, but had equivalent rates of hemorrhagic infarct and subarachnoid hemorrhage when compared with those without. Patients with only periventricular LA did not have a higher rate of parenchymal hematoma. Moderate or severe LA in the DWM was an independent predictor of hemorrhagic transformation (OR, 3.4; P=0.019) and parenchymal hematoma (OR, 6.3; P=0.005). Patients with parenchymal hematoma were less often independent (modified Rankin Scale≤2, 3.8% versus 32.5%; P=0.003) and had greater in-hospital mortality (50% versus 10.4%; P<0.001). Moderate or severe LA in the DWM increases the risk of parenchymal hematoma after Merci thrombectomy for patients with acute stroke. These findings require validation in a larger prospective study.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0039-2499 1524-4628
DOI:	10.1161/STROKEAHA.111.649152