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Abstract
Introduction To determine the influence of white matter hyperintensity (WMH) burden on functional outcome, rate of symptomatic intracerebral hemorrhage (sICH), and procedural success in patients with acute ischemic stroke (AIS) treated by mechanical thrombectomy (MT) with current stentriever/aspiration devices.
Methods Patients with AIS due to large vessel occlusion (LVO) from the Thrombectomie des Artères Cérébrales (THRACE) trial and prospective cohorts from 2 academic comprehensive stroke centers treated with MT were pooled and retrospectively analyzed. WMH volumes were obtained by semiautomated planimetric segmentation and tested in association with the rate of favorable outcome (90-day functional independence), substantial recanalization after MT, and sICH.
Results A total of 496 participants were included between 2015 and 2018 (50% female, mean age 68.1 ± 15.0 years). Overall, 434 (88%) patients presented with detectable WMH (mean ± SD 4.93 ± 7.7). Patients demonstrated increasingly worse outcomes with increasing WMH volumes (odds ratio [aOR]1.05 per 1-cm3 increase for unfavorable outcome, 95% confidence interval [CI] 1.01–1.06, p = 0.014). Fifty-seven percent of patients in the first quartile of WMH volume vs 28% in the fourth quartile demonstrated favorable outcome (p < 0.001). WMH severity was not associated with sICH rate (aOR 0.99, 95% CI 0.93–1.04, p = 0.66), nor did it influence recanalization success (aOR 0.99, 95% CI 0.96–1.02, p = 0.84).
Conclusion Our study provides evidence that in patients with AIS due to LVO and high burden of WMH as assessed by pretreatment MRI, the safety and efficacy profiles of MT are similar to those in patients with lower WMH burden and confirms that they are at higher risk of unfavorable outcome. Because more than a quarter of patients in the highest WMH quartile experienced favorable 3 months outcome, WMH burden may not be a good argument to deny MT.
ClinicalTrials.gov Identifier NCT01062698.
Glossary
- AIS=
- acute ischemic stroke;
- aOR=
- adjusted odds ratio;
- ASPECT=
- Alberta Stroke Program Early CT;
- CI=
- confidence interval;
- DWI=
- diffusion-weighted imaging;
- ECASS II=
- European Cooperative Acute Stroke Study 2;
- FLAIR=
- fluid-attenuated inversion recovery;
- IVT=
- IV thrombolysis;
- LVO=
- large vessel occlusion;
- mRS=
- modified Rankin Scale;
- MT=
- mechanical thrombectomy;
- mTICI=
- modified Treatment in Cerebral Ischemia;
- NIHSS=
- NIH Stroke Scale;
- sICH=
- symptomatic intracerebral hemorrhage;
- THRACE=
- Thrombectomie des Artères Cérébrales;
- tPA=
- tissue plasminogen activator;
- WMH=
- white matter hyperintensity
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 691
CME Course: NPub.org/cmelist
- Received December 28, 2018.
- Accepted in final form June 11, 2019.
- © 2019 American Academy of Neurology
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