Leukoaraiosis predicts cortical infarct volume after distal middle cerebral artery occlusion
Henninger, Nils ; Khan, Muhib ; Zhang, Jiaying ; Moonis, Majaz ; Goddeau, Richard P.
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Keywords
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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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
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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.