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

Jiaying Zhang, A. S. Puri, M. A. Khan, R. P.Goddeau Jr, N. Henninger

Research output: Contribution to journalArticle

Abstract

BACKGROUND 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.

Original languageEnglish (US)
Pages (from-to)2070-2075
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume35
Issue number11
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

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Leukoaraiosis
Stroke
Therapeutics
Tertiary Care Centers
Patient Selection
Biomarkers
Logistic Models
Head
Regression Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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Leukoaraiosis predicts a poor 90-day outcome after endovascular stroke therapy. / Zhang, Jiaying; Puri, A. S.; Khan, M. A.; Jr, R. P.Goddeau; Henninger, N.

In: American Journal of Neuroradiology, Vol. 35, No. 11, 01.11.2014, p. 2070-2075.

Research output: Contribution to journalArticle

Zhang, Jiaying ; Puri, A. S. ; Khan, M. A. ; Jr, R. P.Goddeau ; Henninger, N. / Leukoaraiosis predicts a poor 90-day outcome after endovascular stroke therapy. In: American Journal of Neuroradiology. 2014 ; Vol. 35, No. 11. pp. 2070-2075.
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abstract = "BACKGROUND 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.",
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AU - Zhang, Jiaying

AU - Puri, A. S.

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AU - Henninger, N.

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N2 - BACKGROUND 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.

AB - BACKGROUND 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.

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