Impact of leukoaraiosis on the infarct growth rate and clinical outcome in acute large vessel occlusion stroke after endovascular thrombectomy.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-06-01 Epub Date: 2024-01-17 DOI:10.1177/23969873241226771

Guangchen He, Hui Fang, Bo Xue, Liming Wei, Haitao Lu, Jiangshan Deng, Yueqi Zhu

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Abstract

Introduction: As a marker of chronic cerebral small vessel disease, leukoaraiosis (LA) was reported to impact the recruitment of collaterals in acute ischemic stroke (AIS). We intended to explore the impact of LA on the infarct growth rate (IGR) and clinical outcome by impaired collateral development in AIS patients with large vessel occlusion (LVO) who underwent endovascular thrombectomy (EVT).

Patients and methods: Two hundred thirty-six AIS patients who underwent EVT were retrospectively reviewed. The severity of LA was graded using the Fazekas scale with non-contrast CT. IGR was calculated by the acute core volume on CT perfusion divided by the time from stroke onset to imaging. The collateral status after LVO was assessed using the ASITN/SIR collateral scale. The clinical outcomes after EVT were evaluated using a modified Rankin Scale (mRS). The Alberta stroke program early CT score (ASPECTS), the National Institutes of Health Stroke Scale (NIHSS) score at admission, and the modified treatment in cerebral infarction (mTICI) score after EVT were also included. Correlations between those factors were analyzed.

Results: Patients with severe LA had significantly larger core volume on CTP (p = 0.022) and lower collateral grade (p < 0.001). Faster IGR was significantly associated with higher LA severity (adjusted odds ratio [aOR]: 1.53; 95% CI: 1.02-2.33; p = 0.046), higher NIHSS (aOR: 1.04; 95% CI: 1.00-1.09; p = 0.032) and impaired collaterals (aOR: 2.26; 95% CI: 1.27-4.03; p = 0.005). In mediation analysis, collaterals explained 33% of the effect of LA on fast IGR. There was correlation between the severity of LA and mRS (p = 0.007).

Discussion and conclusion: The increasing severity of LA is associated with impaired collateral status and fast infarct growth. These findings suggest that LA may become a predictive imaging biomarker for the likelihood of progression of tissue injury and clinical outcome after EVT in acute large vessel occlusion stroke.

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血管内血栓切除术后白细胞增多症对急性大血管闭塞性卒中梗塞生长率和临床预后的影响。

导言：据报道，作为慢性脑小血管疾病的标志物，白细胞增多症（LA）会影响急性缺血性卒中（AIS）的侧支募集。我们旨在探讨在接受血管内血栓切除术（EVT）的大血管闭塞（LVO）AIS 患者中，LA 通过损害侧支发展对梗死生长率（IGR）和临床预后的影响：对接受EVT的236例AIS患者进行了回顾性研究。采用法泽卡斯量表和非对比CT对LA的严重程度进行分级。IGR的计算方法是CT灌注的急性核心容积除以从卒中发生到成像的时间。使用 ASITN/SIR 侧支量表评估 LVO 后的侧支状况。EVT后的临床结果采用改良Rankin量表（mRS）进行评估。阿尔伯塔省卒中计划早期 CT 评分（ASPECTS）、入院时的美国国立卫生研究院卒中量表（NIHSS）评分和 EVT 后的改良脑梗死治疗（mTICI）评分也包括在内。分析了这些因素之间的相关性：结果：重度 LA 患者的 CTP 核心体积明显增大（p = 0.022），侧支分级明显降低（p = 0.046），NIHSS 较高（aOR：1.04；95% CI：1.00-1.09；p = 0.032），侧支受损（aOR：2.26；95% CI：1.27-4.03；p = 0.005）。在中介分析中，脉络可解释 LA 对快速 IGR 33% 的影响。LA的严重程度与mRS之间存在相关性（p = 0.007）：讨论与结论：LA严重程度的增加与侧支状态受损和梗死快速生长有关。这些研究结果表明，LA 可能成为急性大血管闭塞性卒中 EVT 后组织损伤进展可能性和临床预后的预测性影像生物标志物。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.