Association of degrees of leukoaraiosis severity with prognoses of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy

Abstract

Objective To assess whether degrees of leukoaraiosis (LA) severity is associated with prognoses of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy. Methods Clinical data of patients with acute anterior circulation large-artery occlusive stroke who underwent mechanical thrombectomy in our hospital from January 2016 to August 2017 were collected. The subjects were divided into non-to-moderate LA group and severe LA group according to preoperative degrees of LA severity; the baseline data, successful reperfusion rate, and symptomatic intracranial hemorrhage rate within 24 h of surgery, good prognosis rate 90 d after surgery(modified Rankin scale [mRS] scores≤2) and mortality 90 d after surgery were analyzed. According to the prognoses, the patients were divided into good prognosis group and poor prognosis group; univariate regression analysis and multivariate Logistic regression analysis were used to evaluate the relations of degrees of LA severity with prognoses 90 d after surgery. Results In these 146 patients, 100 patients were into the non-to-moderate LA group and 46 patients were into the severe LA group. As compared with patients in the non-to-moderate LA group, patients in the severe LA group had significantly older age (70.50 [59.75, 79.75] years vs. 79 [73, 82] years), significantly higher baseline NIHSS scores (20[16, 25]) vs. 22 [18, 28]), significantly higher rate of symptomatic intracranial hemorrhage 24 h after surgery (11.0% [11/100]) vs. 26.1% [12/46]), statistically higher mortality rate 90 d after surgery (14.0%[14/100]) vs. 14.0% [14/46]), significantly lower successful reperfusion rate (97.0% [97/100] vs. 84.8% [39/46]), and statistically lower good prognosis rate (54.0% [54/100] vs. 21.7% [10/46], P<0.05). Among the 146 patients, 64 had good prognosis and 82 had poor prognosis; univariate analysis showed that as compared with than those from the good prognosis group, patients from the poor prognosis group had significantly older age (70.50 [59.75, 79.75] years old vs. 79 [73, 82] years old) and statistically higher baseline NIHSS scores (20 [16, 25] vs. 22 [18, 28]), and significantly higher proportion of central source embolism by TOAST etiology classification (68.8% [44/64] vs. 76.8%[63/82]) and proportion of severe LA (15.6% [10/64] vs. 43.9% [36/82], P<0.05); multivariate Logistic regression analysis showed that severe LA (OR=3.109, 95%CI: 1.241-7.788, P=0.015), age, baseline NIHSS scores, and TOAST etiology classification were all independent risk factors for poor prognosis 90 d after surgery (P<0.05). Conclusion Severe LA may be associated with poor prognosis of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy. Key words: Ischemic stroke; Thrombectomy; Leukoaraiosis; Prognosis