Document Detail


Leukoaraiosis predicts parenchymal hematoma after mechanical thrombectomy in acute ischemic stroke.
MedLine Citation:
PMID:  22581819     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: The purpose of this study was to determine whether leukoaraiosis (LA) predicts hemorrhagic transformation and poor outcome in patients with acute ischemic stroke treated by mechanical thrombectomy.
METHODS: We retrospectively analyzed patients with anterior circulation stroke treated with Merci devices and identified LA in the deep white matter (DWM) and periventricular white matter on the preintervention MR images. We dichotomized patients into those with moderate or severe LA in the DWM versus those without. Hemorrhage rates and outcomes were evaluated between 2 groups. We analyzed the association of moderate or severe LA with hemorrhagic transformation and poor outcome.
RESULTS: Twenty-six of 105 patients had moderate or severe LA in the DWM. Patients with moderate or severe LA in the DWM were older, had more severe neurological deficits and worse outcome, had higher rates of hemorrhagic transformation and parenchymal hematoma, but had equivalent rates of hemorrhagic infarct and subarachnoid hemorrhage when compared with those without. Patients with only periventricular LA did not have a higher rate of parenchymal hematoma. Moderate or severe LA in the DWM was an independent predictor of hemorrhagic transformation (OR, 3.4; P=0.019) and parenchymal hematoma (OR, 6.3; P=0.005). Patients with parenchymal hematoma were less often independent (modified Rankin Scale≤2, 3.8% versus 32.5%; P=0.003) and had greater in-hospital mortality (50% versus 10.4%; P<0.001).
CONCLUSIONS: Moderate or severe LA in the DWM increases the risk of parenchymal hematoma after Merci thrombectomy for patients with acute stroke. These findings require validation in a larger prospective study.
Authors:
Zhong-Song Shi; Yince Loh; David S Liebeskind; Jeffrey L Saver; Nestor R Gonzalez; Satoshi Tateshima; Reza Jahan; Lei Feng; Paul M Vespa; Sidney Starkman; Noriko Salamon; J Pablo Villablance; Latisha K Ali; Bruce Ovbiagele; Doojin Kim; Fernando Viñuela; Gary R Duckwiler
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-05-10
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  43     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-26     Completed Date:  2012-09-04     Revised Date:  2013-07-23    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1806-11     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. zhongsongshi@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Brain Ischemia / epidemiology*,  therapy
Cohort Studies
Female
Hematoma, Subdural, Chronic / epidemiology*,  therapy
Humans
Leukoaraiosis / epidemiology*,  therapy
Male
Mechanical Thrombolysis / adverse effects*
Middle Aged
Predictive Value of Tests
Prospective Studies
Retrospective Studies
Stroke / epidemiology*,  therapy
Grant Support
ID/Acronym/Agency:
K23 NS054084/NS/NINDS NIH HHS; K23 NS054084/NS/NINDS NIH HHS; K24 NS072272/NS/NINDS NIH HHS; P50 NS044378/NS/NINDS NIH HHS; P50 NS044378/NS/NINDS NIH HHS
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