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  • Impact of leukoaraiosis in patients with acute ischemic stroke treated with thrombectomy: a post hoc analysis of the DIRECT-MT trial

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Ischemic stroke
Original research
Impact of leukoaraiosis in patients with acute ischemic stroke treated with thrombectomy: a post hoc analysis of the DIRECT-MT trial
  1. Tingyu Yi1,
  2. Yongxin Zhang2,
  3. Wen-huo Chen1,
  4. Yan-min Wu1,
  5. Ding-lai Lin1,
  6. Xiao-hui Lin1,
  7. Lei Zhang2,
  8. Peng-fei Xing2,
  9. Tianxiao Li3,
  10. Yongwei Zhang2,
  11. Shouchun Wang4,
  12. Pengfei Yang2,
  13. Ming-zhi Cai5,
  14. Jianmin Liu2
  15. On behalf of for the DIRECT-MT Investigators
  1. 1 Department of Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
  2. 2 Department of Cerebralvascular Disease Center, Changhai Hospital, Shanghai, China
  3. 3 Department of Cerebralvascular Disease Center, Henan Provincial People's Hospital, Zhengzhou, Henan, China
  4. 4 Department of Neurology and Neuroscience Center, Jilin University First Hospital, Changchun, Jilin, China
  5. 5 Department of Vascular Surgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
  1. Correspondence to Dr Pengfei Yang, Department of Neurosurgery, Changhai Hospital, Shanghai, China; p.yang{at}vip.163.com; Dr Ming-zhi Cai; 308478467{at}163.com

Abstract

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.

  • intervention
  • stroke
  • thrombectomy

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

https://doi.org/10.1136/neurintsurg-2021-018293

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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    Footnotes

    • TY and YZ contributed equally.

    • Collaborators Co-author of DIRECT-MT Investigators is listed in online supplemental appendix table.

    • Contributors TY: substantial contributions to the conception; drafting the work and revising it critically for important intellectual content; final approval of the version to be published. YZ: revising the manuscript critically for important intellectual content; final approval of the version to be published. WC: substantial contributions to the conception, revising the manuscript critically for important intellectual content; final approval of the version to be published. YW, DL, XL: acquisition, analysis, or interpretation of data for the work; final approval of the version to be published. LZ, PX, TL, YZ, SW: revising the manuscript critically for important intellectual content; interpretation of data for the work. PY' MC: agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JL: substantial contributions to the design of the work, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding Sponsored by National Health commission capacity building and continuing education center (grant number: GWJJ2021100203).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.