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.
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Authors | Tingyu Yi, Yongxin Zhang, Wen-Huo Chen, Yan-Min Wu, Ding-Lai Lin, Xiao-Hui Lin, Lei Zhang, Peng-Fei Xing, Tianxiao Li, Yongwei Zhang, Shouchun Wang, Pengfei Yang, Ming-Zhi Cai, Jianmin Liu, for the DIRECT-MT Investigators |
Journal | Journal of neurointerventional surgery
(J Neurointerv Surg)
Vol. 15
Issue 2
Pg. 139-145
(Feb 2023)
ISSN: 1759-8486 [Electronic] England |
PMID | 35101958
(Publication Type: Randomized Controlled Trial, Journal Article)
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Copyright | © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. |
Chemical References |
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Topics |
- Humans
- Stroke
(diagnostic imaging, therapy, complications)
- Ischemic Stroke
(etiology)
- Brain Ischemia
(complications, diagnostic imaging, therapy)
- Treatment Outcome
- Thrombectomy
(adverse effects)
- Intracranial Hemorrhages
(etiology)
- Leukoaraiosis
(complications, diagnostic imaging)
- Thrombolytic Therapy
(adverse effects)
- Fibrinolytic Agents
(therapeutic use)
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