White matter burden does not influence the outcome of mechanical thrombectomy
Laura Mechtouff1, Norbert Nighoghossian2, Camille Amaz3
1Department of Neurology and Comprehensive Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France.
Background And Purpose:
The significance of white matter hyperintensities (WMHs) in the setting of mechanical thrombectomy (MT) remains poorly documented. We assessed whether pre-existing WMHs burden was associated with baseline clinical and imaging factors and neurological outcome in patients undergoing MT.
Methods:
This retrospective single-center study included consecutive acute ischemic stroke (AIS) patients with stroke due to large vessel occlusion treated with MT. WMHs were assessed on baseline T2 fluid-attenuated inversion recovery magnetic resonance imaging. Neurological outcome was assessed at day 90 by the modified Rankin Scale (mRS). We analyzed the association between WMH burden and clinical and imaging factors by univariate and multivariate logistic regression analyses.
Results:
Between July 2013 and June 2019, 293 patients with anterior circulation AIS met the inclusion criteria. WMHs burden was not associated to baseline NIHSS score severity (OR 0.89, 95% CI 0.54-1.49, p = 0.66), poor collateral status, Higashida score < 3 (OR 1.5 95% CI 0.62-3.56, p = 0.36), higher DWI volume (OR 0.69, 95% CI 0.41-1.15, p = 0.16) or to a lower recanalization rate, TICI 0/2a (OR 0.98 95% CI 0.56-1.69, p = 0.95). WMHs severity did not influence the risk of parenchymal hemorrhage (OR 0.97 95% 0.26-3, p = 0.96). WMHs burden was not an independent predictor of poor outcome in multivariate analysis. The rate of futile recanalization in patients with TICI grades 2b and 3 according to mRs score at 3 months was not influenced by WMHs burden.
Conclusions:
WMHs burden does not seem to influence clinical outcome and imaging parameters in patients treated by MT.
Insights
White matter hyperintensities (WMHs) burden did not significantly impact clinical outcomes or imaging results in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke. This study found no association between WMH severity and neurological recovery after MT.
Area of Science:
- Neurology
- Radiology
- Interventional Neuroradiology
Background:
- White matter hyperintensities (WMHs) are common in stroke patients but their impact on mechanical thrombectomy (MT) outcomes is not well-established.
- Assessing pre-existing WMH burden is crucial for understanding treatment efficacy in acute ischemic stroke (AIS).
Purpose of the Study:
- To evaluate the association between pre-existing white matter hyperintensities (WMHs) burden and clinical/imaging factors in patients undergoing mechanical thrombectomy (MT).
- To determine if WMH burden predicts neurological outcome after MT for AIS.
Main Methods:
- Retrospective analysis of 293 anterior circulation AIS patients treated with MT.
- WMHs assessed on baseline T2-FLAIR MRI; neurological outcome evaluated using modified Rankin Scale (mRS) at 90 days.
- Univariate and multivariate logistic regression analyses explored associations between WMH burden and clinical/imaging variables.
Main Results:
- WMH burden showed no significant association with baseline NIHSS, collateral status, DWI volume, or recanalization rates (TICI 0/2a).
- WMH severity did not influence the risk of parenchymal hemorrhage or predict poor neurological outcome in multivariate analysis.
- Futile recanalization rates were not affected by WMH burden in patients with successful recanalization (TICI 2b-3).
Conclusions:
- Pre-existing white matter hyperintensities (WMHs) burden does not appear to significantly influence clinical outcomes or key imaging parameters in patients undergoing mechanical thrombectomy (MT).
- Further research may clarify the role of WMHs in specific stroke subtypes or MT techniques.
