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    Leukoaraiosis predicts cortical infarct volume after distal middle cerebral artery occlusion

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    Authors
    Henninger, Nils
    Khan, Muhib
    Zhang, Jiaying
    Moonis, Majaz
    Goddeau, Richard P.
    UMass Chan Affiliations
    Department of Neurology
    Document Type
    Journal Article
    Publication Date
    2014-03-01
    Keywords
    Aged
    Aged, 80 and over
    Cerebral Angiography
    Endovascular Procedures
    Female
    Humans
    Image Processing, Computer-Assisted
    Infarction, Middle Cerebral Artery
    Leukoaraiosis
    Male
    Middle Aged
    Neuroimaging
    Predictive Value of Tests
    ROC Curve
    Recovery of Function
    Regression Analysis
    Retrospective Studies
    Risk Factors
    Thrombolytic Therapy
    Tomography, X-Ray Computed
    Treatment Outcome
    cerebral small vessel diseases
    leukoaraiosis
    stroke
    stroke
    lacunar
    Nervous System Diseases
    Neurology
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    Link to Full Text
    http://dx.doi.org/10.1161/STROKEAHA.113.002855
    Abstract
    BACKGROUND AND PURPOSE: Leukoaraiosis (LA) predominantly affects the subcortical white matter, but mounting evidence suggests an association with cortical microvascular dysfunction and potentially decreased cortical ischemic tolerance. Thus, we sought to assess whether preexisting LA is predictive of the cortical infarct volume after middle cerebral artery branch occlusion and whether it relates to a worse outcome. METHODS: We analyzed data from 117 consecutive patients with middle cerebral artery branch occlusion as documented by admission computed tomography angiography. Baseline clinical, laboratory, and outcome data, as well as final cortical infarct volumes, were retrospectively analyzed from a prospectively collected database. LA severity was assessed on admission computed tomography using the van Swieten scale grading the supratentorial white matter hypoattenuation. Infarct volume predicting a favorable 90-day outcome (modified Rankin Scale score≤2) was determined by receiver operating characteristic curves. Multivariable linear and logistic regression analyses were used to identify independent predictors of the final infarct volume and outcome. RESULTS: Receiver operating characteristic curve analyses indicated that a final infarct volume of ≤27 mL best predicted a favorable 90-day outcome. Severe LA (odds ratio, 11.231; 95% confidence interval, 2.526-49.926; P=0.001) was independently associated with infarct volume>27 mL. Severe LA (odds ratio, 3.074; 95% confidence interval, 1.055-8.961; P=0.040) and infarct volume>27 mL (odds ratio, 9.156; 95% confidence interval, 3.191-26.270; P < .0001) were independent predictors of a poor 90-day outcome (modified Rankin Scale, 3-6). CONCLUSIONS: The presence of severe, subcortical LA contributes to larger cortical infarct volumes and worse functional outcomes adding to the notion that the brain is negatively affected beyond LA's macroscopic boundaries.
    Source
    Stroke. 2014 Mar;45(3):689-95. doi: 10.1161/STROKEAHA.113.002855. Epub 2014 Feb 12. Link to article on publisher's site
    DOI
    10.1161/STROKEAHA.113.002855
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/37762
    PubMed ID
    24523039
    Notes

    First author Nils Henninger is a doctoral student in the Millennium PhD Program (MPP) in the Graduate School of Biomedical Sciences (GSBS) at UMass Medical School.

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    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1161/STROKEAHA.113.002855
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