RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd.
SP 139
OP 145
DO 10.1136/neurintsurg-2021-018293
VO 15
IS 2
A1 Tingyu Yi
A1 Yongxin Zhang
A1 Wen-huo Chen
A1 Yan-min Wu
A1 Ding-lai Lin
A1 Xiao-hui Lin
A1 Lei Zhang
A1 Peng-fei Xing
A1 Tianxiao Li
A1 Yongwei Zhang
A1 Shouchun Wang
A1 Pengfei Yang
A1 Ming-zhi Cai
A1 Jianmin Liu
A1 ,
YR 2023
UL http://jnis.bmj.com/content/15/2/139.abstract
AB 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.