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Updated: Jul 3, 2026
A Versatile Murine Model of Subcortical White Matter Stroke for the Study of Axonal Degeneration and White Matter Neurobiology
Published on: March 17, 2016
Relationship of white matter lesion severity with early and late outcomes after mechanical thrombectomy for large
Zimbul Albo1, Jose Marino2, Muhammad Nagy2
1Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Background:
White matter lesions (WML) are associated with poor outcome after mechanical thrombectomy (MT) for large vessel stroke; the reasons are uncertain. To elucidate this issue we sought to determine the association of WML with multiple early and late outcome measures after MT.
Methods:
We retrospectively analyzed 181 MT patients prospectively included in our local stroke registry (January 2012 to November 2016). Using multiple regression modeling, we assessed whether WML was independently associated with early outcomes (successful recanalization, degree of National Institutes of Health Stroke Scale (NIHSS) improvement, hemorrhagic transformation, duration of hospitalization) as well as an unfavorable 90-day modified Rankin Scale score (mRS) (≥3) and 90-day survival. Explorative analyses examined the association with the 90-day home-time and 90-day risk for hospital readmission.
Results:
WML were not significantly associated with early outcome measure (P>0.05, each). Patients with moderate-to-severe WML more often had an unfavorable mRS (OR 2.93, 95% CI 1.04 to 8.33) and risk of death (HR 1.98, 95% CI 1.03 to 3.84) after adjustment for pertinent confounders. Patients with moderate-to-severe WML had a significantly shorter home-time (19±32 vs 47±38 days, P<0.001) and Kaplan-Meier analyses indicated a significantly greater risk for hospital readmission within 90 days (log rank P=0.045), with the most frequent reasons being recurrent stroke and transient ischemic attack.
Conclusion:
Our analyses suggest that poor outcomes among patients with moderate-to-severe WML were related to factors unrelated to procedural success and risk. WML should not be used to render treatment decisions in otherwise eligible patients. Aggressive monitoring of medical complications after MT could represent a viable strategy to improve outcome in affected patients.
Insights
Moderate-to-severe white matter lesions (WML) in stroke patients undergoing mechanical thrombectomy (MT) are linked to worse outcomes, including higher mortality and readmission rates. These findings suggest WML severity should not preclude MT eligibility but warrants closer post-procedure monitoring.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- White matter lesions (WML) are recognized predictors of poor outcomes following mechanical thrombectomy (MT) for large vessel stroke.
- The underlying reasons for this association remain unclear, necessitating further investigation into the impact of WML on MT efficacy and patient recovery.
Purpose of the Study:
- To investigate the independent association between white matter lesions (WML) and both early and late outcome measures in patients undergoing mechanical thrombectomy (MT).
- To determine if WML influences procedural success, functional recovery, survival, and hospital readmission rates after MT.
Main Methods:
- Retrospective analysis of 181 patients who underwent MT and were included in a prospective stroke registry.
- Multiple regression modeling was used to assess the association of WML with early outcomes (recanalization, NIHSS improvement, hemorrhagic transformation, hospitalization duration) and late outcomes (90-day mRS, survival, home-time, readmission risk).
- Exploratory analyses examined the impact of WML on 90-day home-time and hospital readmission risk.
Main Results:
- White matter lesions (WML) were not significantly associated with early outcome measures after mechanical thrombectomy (MT).
- Patients with moderate-to-severe WML demonstrated a significantly higher likelihood of an unfavorable 90-day modified Rankin Scale (mRS) score (OR 2.93) and increased risk of death (HR 1.98) after adjustment.
- Moderate-to-severe WML correlated with shorter home-time (19 vs 47 days) and a greater risk of 90-day hospital readmission, primarily due to recurrent stroke or transient ischemic attack.
Conclusions:
- Poor outcomes in patients with moderate-to-severe white matter lesions (WML) after mechanical thrombectomy (MT) appear unrelated to procedural success.
- WML severity should not be a sole determinant for excluding otherwise eligible patients from MT.
- Enhanced monitoring for medical complications in MT patients with moderate-to-severe WML may improve clinical outcomes.
