Abstract 2269: Leukoaraiosis Predicts 90-day Outcome After Intracranial Large Artery Occlusion
Background: Intracranial large artery occlusion (ILAO) accounts for a significant number of ischemic strokes and predicts a poor outcome. However, factors modifying the outcome following ILAO remain incompletely characterized. Leukoaraiosis (LA), which is a frequent finding in stroke patients, has been associated with poor post-stroke outcomes. However, its contribution to patient outcome after ILAO remains to be clarified. We sought to determine the association between LA-severity and 90-day outcomes in patients following anterior circulation ILAO.
Methods: We retrospectively analyzed 1153 consecutive patients with imaging confirmed ischemic stroke during a 4-year period (2007-2010). The final study cohort included 87 patients with acute ILAO subjected to multimodal CT-imaging within 24 hours of symptom onset. LA-severity was assessed using the van Swieten scale on non-contrast CT. Leptomeningeal collaterals were graded using CT-angiogram source images. Hemorrhagic infarction was determined on follow-up CT. Multivariate logistic regression controlling for hemorrhagic infarction, treatment modality, demographic, as well as baseline clinical and imaging characteristics was used to identify independent predictors for outcome.
Results: Factors independently associated with poor outcome (90-day mRS≥3) were admission NIHSS (p=0.0001; OR 5.11; 95% CI, 2.07-14.49 for each 10-point increase) and severe LA (p=0.0056; OR 13.86; 95% CI, 1.94-∞; Figure). There was a trend for an association between presence of hemorrhagic conversion and poor outcome (p=0.0572; OR 4.82; CI 0.96-32.65). Compared to patients with none-to-moderate LA, patients with severe LA were more likely to have hypertension (p=0.027), coronary artery disease (p=0.008), poor collaterals (p<0.001), higher admission NIHSS (p=0.003), higher mRS at 90 days (p<0.001), and they were older (p=0.002). Patients with severe LA had a uniformly poor outcome (p<0.001).
Conclusion: In addition to NIHSS, the severity of pre-existing LA has substantial impact on outcome in patients with acute ILAO and may prove to be an important factor to guide clinical decision making.
Figure: Functional outcome by Leukoaraiosis grades Functional outcome at 90 days (modified Rankin Score, mRS) stratified by severity of Leukoaraiosis (LA) grades (van Swieten Score 0-2 vs. 3-4, P<0.001). Numbers indicate n per mRS-category.
- © 2012 by American Heart Association, Inc.