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Original research
Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke
  1. Dan-Victor Giurgiutiu1,3,
  2. Albert J Yoo2,
  3. Kaitlin Fitzpatrick1,
  4. Zeshan Chaudhry2,
  5. Thabele Leslie-Mazwi1,2,
  6. Lee H Schwamm1,
  7. Natalia S Rost1
  1. 1Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Neuroendovascular Service, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr D-V Giurgiutiu, Stroke Service, Department of Neurology, Massachusetts General Hospital, 200 Lothrop Street, Pittsburgh, PA 15213, USA; giurgiut{at}gmail.com

Abstract

Background and purpose Leukoaraiosis (LA) is defined as ischemic white matter lesions associated with increased stroke risk and poor post-stroke outcomes. These lesions are likely the result of diffuse angiopathic changes affecting the cerebral small vessels. We investigated whether pre-existing LA burden is associated with outcomes in patients with large cerebral artery occlusion undergoing intra-arterial therapy (IAT) for acute ischemic stroke (AIS).

Methods We analyzed consecutive AIS subjects undergoing IAT from the institutional Get With The Guidelines-Stroke database enrolled between January 1, 2007 and June 30, 2009, who had National Institutes of Health Stroke Scale scores of ≥8, baseline diffusion weighted imaging volume ≤100 mL, and evidence of proximal artery occlusion (PAO) on pre-IAT computed tomography angiography (CTA). LA volume (LAv) was assessed on fluid attenuated inversion recovery MRI using a validated semi-automated protocol. We used CTA for collateral grade, post-IAT angiogram for recanalization status (Thrombolysis in Cerebral Infarction score ≥2b), and the 24 h head CT for symptomatic intracranial hemorrhage. Logistic regression was used to determine independent predictors of 90 day post-stroke good functional outcome (modified Rankin Scale score ≤2) and mortality.

Results Increasing LAv independently reduced the odds of good collateral grade (OR 0.85, 95% CI 0.73 to 0.98). Good functional outcome was independently predicted by intravenous tissue plasminogen activator use (OR 12.86, 95% CI 2.20 to 76.28), and recanalization status (OR 6.94, 95% CI 1.56 to 30.86). Mortality was independently associated with recanalization status (OR 0.08, 95% CI 0.01 to 0.51), age (OR 1.08, 95% CI 1.01 to 1.15), and antecedent use of hypoglycemic agents (OR 6.55, 95% CI 1.58 to 54.01).

Conclusions Severity of LA is linked to poor collateral grade in AIS patients undergoing IAT for PAO; however, greater LAv appears not to be a contraindication for acute intervention.

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