Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke

Dan-Victor Giurgiutiu, Albert J. Yoo, Kaitlin Fitzpatrick, Zeshan Chaudhry, Thabele Leslie-Mazwi, Lee H. Schwamm, Natalia S. Rost

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)326-330
Number of pages5
JournalJournal of NeuroInterventional Surgery
Volume7
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

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Leukoaraiosis
Stroke
Therapeutics
Arteries
Cerebral Arteries
Mortality
Intracranial Hemorrhages
Cerebral Infarction
National Institutes of Health (U.S.)
Tissue Plasminogen Activator
Hypoglycemic Agents
Angiography
Logistic Models
Head
Databases
Guidelines

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke. / Giurgiutiu, Dan-Victor; Yoo, Albert J.; Fitzpatrick, Kaitlin; Chaudhry, Zeshan; Leslie-Mazwi, Thabele; Schwamm, Lee H.; Rost, Natalia S.

In: Journal of NeuroInterventional Surgery, Vol. 7, No. 5, 01.05.2015, p. 326-330.

Research output: Contribution to journalArticle

Giurgiutiu, Dan-Victor ; Yoo, Albert J. ; Fitzpatrick, Kaitlin ; Chaudhry, Zeshan ; Leslie-Mazwi, Thabele ; Schwamm, Lee H. ; Rost, Natalia S. / Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke. In: Journal of NeuroInterventional Surgery. 2015 ; Vol. 7, No. 5. pp. 326-330.
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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.",
author = "Dan-Victor Giurgiutiu and Yoo, {Albert J.} and Kaitlin Fitzpatrick and Zeshan Chaudhry and Thabele Leslie-Mazwi and Schwamm, {Lee H.} and Rost, {Natalia S.}",
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T1 - Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke

AU - Giurgiutiu, Dan-Victor

AU - Yoo, Albert J.

AU - Fitzpatrick, Kaitlin

AU - Chaudhry, Zeshan

AU - Leslie-Mazwi, Thabele

AU - Schwamm, Lee H.

AU - Rost, Natalia S.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - 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.

AB - 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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