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Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
White matter hyperintensity burden and functional outcomes in acute ischemic stroke patients after mechanical
Huanhuan Fan1, Lihua Wei1, Xiaolin Zhao1
1Department of Neurology, Nanfang Hospital, Southern Medical University, China.
Background:
The influence of white matter hyperintensity (WMH) on clinical outcomes in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT) remains controversial. We performed a systematic review and meta-analysis to examine whether WMH burden is associated with clinical outcomes in AIS patients after MT.
Methods:
PubMed, Embase, and Web of Science were searched from inception to Sep 03, 2023. The registration number for PROSPERO is CRD42022340568. Studies reporting an association between the burden of WMH in AIS patients and clinical outcomes after MT were included in the meta-analysis. A random-effects model was used for meta-analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Additionally, the presence of imprecise-study effects was evaluated using Egger's test and funnel plot.
Results:
Fifteen studies with 3,456 patients were enrolled in this meta-analysis. Among AIS patients who underwent MT, moderate/severe WMH had higher odds of 90-day unfavorable functional outcomes (odds ratio [OR] 2.72, 95% confidence interval [CI] 2.14-3.44; I2 = 0.0%; 95% CI 0.0%-42.7%), 90-day mortality (OR 1.94, 95% CI 1.45-2.60; I2 = 19.5%; 95% CI 0.0%-65.2%) and futile recanalization (OR 2.99, 95% CI 1.42-6.28; I2 = 69.7%; 95% CI 0.0%-91.0%) compared with none/mild WMH. However, the two groups had no significant difference in successful recanalization, symptomatic hemorrhagic transformation, and hemorrhagic transformation. A subset analysis of patients from 3 articles showed that WMH volume was not significantly associated with these outcomes. A notable limitation is that this meta-analysis lacks direct adjustment for imbalances in important baseline covariates.
Conclusions:
Patients with moderate/severe WMH on baseline imaging are associated with substantially increased odds of 90-day unfavorable outcomes, futile recanalization, and 90-day mortality after MT. This association suggests that moderate/severe WMH may contribute to the prediction of clinical outcomes in AIS patients after MT.
Insights
White matter hyperintensity (WMH) significantly increases the risk of poor outcomes, mortality, and futile recanalization in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). This finding highlights WMH as a crucial factor in predicting post-MT prognosis.
Area of Science:
- Neurology
- Radiology
- Clinical Medicine
Background:
- The prognostic value of white matter hyperintensity (WMH) in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT) is debated.
- Existing research presents conflicting results regarding the association between WMH burden and clinical outcomes post-MT.
Conclusions:
- Moderate to severe WMH on baseline imaging is a significant predictor of adverse clinical outcomes, including unfavorable functional status, futile recanalization, and increased mortality at 90 days post-MT.
- These findings suggest that WMH burden should be considered in the prognostic assessment of AIS patients undergoing MT.
- Further research may be needed to address limitations such as covariate adjustment for a more refined understanding.
