Mikati, Abdul GhaniMandelbaum, MaxSapnar, ShwetaPuri, Ajit SSilver, BrianGoddeau, Richard P. JrHaussen, Diogo C.Moonis, MajazJun-O'Connell, Adalia H.Henninger, Nils2022-08-232022-08-232020-02-012021-09-03<p>Mikati AG, Mandelbaum M, Sapnar S, Puri AS, Silver B, Goddeau RP Jr, Haussen DC, Moonis M, Jun-O'Connell AH, Henninger N. Impact of Leukoaraiosis Severity on the Association of Time to Successful Reperfusion with 90-Day Functional Outcome After Large Vessel Occlusion Stroke. Transl Stroke Res. 2020 Feb;11(1):39-49. doi: 10.1007/s12975-019-00703-0. Epub 2019 Apr 12. PMID: 30980282; PMCID: PMC6925352. <a href="https://doi.org/10.1007/s12975-019-00703-0">Link to article on publisher's site</a></p>1868-4483 (Linking)10.1007/s12975-019-00703-030980282https://hdl.handle.net/20.500.14038/48549The chance for a favorable outcome after mechanical thrombectomy (MT) for large vessel occlusion stroke decreases with the symptom onset-to-reperfusion time (OTR). Patients with severe leukoaraiosis are at increased risk for a poor outcome after MT. However, whether leukoaraiosis modulates to the association between OTR and 90-day functional outcome is uncertain. We retrospectively analyzed 144 consecutive patients with successful (TICI > /= 2b/3) MT for anterior circulation large vessel occlusion within 24 h form OTR between January 2012 to November 2016. Leukoaraiosis was dichotomized to absent-to-mild (van Swieten scale score 0-2) versus moderate-to-severe (3-4) as assessed on admission head CT. Multiple linear, logistic, and ordinal regression analyses were used to determine the association between leukoaraiosis, OTR, and 90-day modified Rankin Scale (mRS) score, after adjustment for pertinent covariates. Leukoaraiosis was independently associated with the OTR on multivariable linear regression (p = 0.003). The association between OTR and 90-day outcome depended on the degree of pre-existing leukoaraiosis burden as shown by a significant leukoaraiosis-by-OTR interaction on multivariable logistic regression (OR 0.76, 95% CI 0.58-0.98, p = 0.037) and multivariable ordinal regression (OR 0.87, 95% CI 0.78-0.97, p = 0.011). Pre-existing leukoaraiosis is associated with the 90-day functional outcome after successful reperfusion and impacts the association between the OTR and 90-day mRS among patients undergoing MT. Patients with high leukoaraiosis burden need to present earlier than patients with low leukoaraiosis burden for a similar favorable outcome. Pending confirmation, these results may have important implications for optimizing patient selection for acute stroke therapies.en-USASPECTSCollateralsEndovascular thrombectomyLarge vessel occlusionLeukoaraiosisRecanalizationSmall vessel diseaseCardiovascular DiseasesNervous System DiseasesNeurologyTranslational Medical ResearchJournal Articlehttps://escholarship.umassmed.edu/radiology_pubs/64824651284radiology_pubs/648