| Autor: |
Mikati AG; Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA, 01655, USA., Mandelbaum M; Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA, 01655, USA., Sapnar S; Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA, 01655, USA., Puri AS; Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA.; Department of Neurosurgery, University of Massachusetts Medical School, Worcester, MA, USA., Silver B; Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA, 01655, USA., Goddeau RP Jr; Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA, 01655, USA., Haussen DC; Department of Neurology, Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, GA, USA., Moonis M; Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA, 01655, USA., Jun-O'Connell AH; Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA, 01655, USA., Henninger N; Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA, 01655, USA. nils.henninger@umassmed.edu.; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA. nils.henninger@umassmed.edu. |
| Abstrakt: |
The chance for a favorable outcome after mechanical thrombectomy (MT) for large vessel occlusion stroke decreases with the symptom onset-to-reperfusion time (OTR). Patients with severe leukoaraiosis are at increased risk for a poor outcome after MT. However, whether leukoaraiosis modulates to the association between OTR and 90-day functional outcome is uncertain. We retrospectively analyzed 144 consecutive patients with successful (TICI ≥ 2b/3) MT for anterior circulation large vessel occlusion within 24 h form OTR between January 2012 to November 2016. Leukoaraiosis was dichotomized to absent-to-mild (van Swieten scale score 0-2) versus moderate-to-severe (3-4) as assessed on admission head CT. Multiple linear, logistic, and ordinal regression analyses were used to determine the association between leukoaraiosis, OTR, and 90-day modified Rankin Scale (mRS) score, after adjustment for pertinent covariates. Leukoaraiosis was independently associated with the OTR on multivariable linear regression (p = 0.003). The association between OTR and 90-day outcome depended on the degree of pre-existing leukoaraiosis burden as shown by a significant leukoaraiosis-by-OTR interaction on multivariable logistic regression (OR 0.76, 95% CI 0.58-0.98, p = 0.037) and multivariable ordinal regression (OR 0.87, 95% CI 0.78-0.97, p = 0.011). Pre-existing leukoaraiosis is associated with the 90-day functional outcome after successful reperfusion and impacts the association between the OTR and 90-day mRS among patients undergoing MT. Patients with high leukoaraiosis burden need to present earlier than patients with low leukoaraiosis burden for a similar favorable outcome. Pending confirmation, these results may have important implications for optimizing patient selection for acute stroke therapies. |
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