TY - JOUR T1 - Impact of leukoaraiosis in patients with acute ischemic stroke treated with thrombectomy: a post hoc analysis of the DIRECT-MT trial JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 139 LP - 145 DO - 10.1136/neurintsurg-2021-018293 VL - 15 IS - 2 AU - Tingyu Yi AU - Yongxin Zhang AU - Wen-huo Chen AU - Yan-min Wu AU - Ding-lai Lin AU - Xiao-hui Lin AU - Lei Zhang AU - Peng-fei Xing AU - Tianxiao Li AU - Yongwei Zhang AU - Shouchun Wang AU - Pengfei Yang AU - Ming-zhi Cai AU - Jianmin Liu A2 - , Y1 - 2023/02/01 UR - http://jnis.bmj.com/content/15/2/139.abstract N2 - Background The influence of leukoaraiosis in patients with acute ischemic stroke (AIS) given intra-arterial treatment (IAT) with or without preceding intravenous thrombolysis (IVT) remains unknown.Objective To assess the clinical and radiological outcomes of IAT in patients with or without leukoaraiosis.Methods Patients of the direct mechanical thrombectomy trial (DIRECT-MT) whose leukoaraiosis grade could be assessed were included. DIRECT-MT was a randomized clinical trial performed in China to assess the effect of direct IAT compared with intravenous thrombolysis plus IAT. We employed the Age-Related White Matter Changes Scale for grading leukoaraiosis (ARWMC, 0 indicates no leukoaraiosis, 1–2 indicates mild-to-moderate leukoaraiosis, and 3 indicates severe leukoaraiosis) based on brain CT. The primary outcome was the score on the modified Rankin Scale (mRS) assessed at 90 days.Results There were 656 patients in the trial, 649 patients who were included, with 432 patients without leukoaraiosis, and 217 (33.4%) patients with leukoaraiosis divided into mild-to-moderate (n=139) and severe groups (n=78). Leukoaraiosis was a predictor of a worse mRS score (adjusted OR (aOR)=0.7 (95% CI 0.5 to 0.8)) and higher mortality (aOR=1.4 (1.1 to 1.9)), but it was not associated with symptomatic intracranial hemorrhage (sICH) (aOR=0.9 (0.5 to 1.5)). IVT preceding IAT did not increase sICH risk for patients with no (aOR=1.4 (0.6 to 3.4)), mild-to-moderate (aOR=1.5 (0.3 to 7.8)), or severe (aOR=1.5 (0.1 to 21.3)) leukoaraiosis.Conclusion Patients with leukoaraiosis with AIS due to large vessel occlusion are at increased risk of a poor functional outcome after IAT but demonstrate similar sICH rates, and IVT preceding IAT does not increase the risk of sICH in Chinese patients with leukoaraiosis.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable. ER -