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Small vessel disease and clinical outcomes after endovascular treatment in acute ischemic stroke

  • Francesco ArbaEmail author
  • Giuseppe Dario Testa
  • Nicola Limbucci
  • Sergio Nappini
  • Leonardo Renieri
  • Giovanni Pracucci
  • Patrizia Nencini
  • Domenico Inzitari
Original Article
  • 23 Downloads

Abstract

Background

Pre-existing small vessel disease (SVD) has been associated with poor functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis; however, there are scarce data in patients treated with endovascular therapy. We aimed to investigate the associations between SVD and clinical outcomes in patients treated with endovascular therapy.

Methods

We retrospectivel y evaluated patients with acute ischemic stroke in the anterior circulation receiving endovascular treatment. We assessed SVD markers with visual scales using non-contrast computed tomography. Early outcomes included intracerebral hemorrhage and 7-day/discharge stroke severity, and late outcomes included modified Rankin scale (mRS) 90 days after stroke. We used logistic and ordinal regression models adjusted for age, sex, stroke severity, and time-to-groin puncture time.

Results

A total of 175 patients were included in the study, mean (±SD) age 72.3 (± 12.4) years, 90 (51%) males. Among SVD features, only brain atrophy was associated with 7-day stroke severity (OR = 2.28; 95% CI = 1.11–4.68) and with worse mRS at 90 days (OR = 2.72; 95% CI = 1.25–5.91). Global SVD burden was associated with worse mRS at 90 days (OR = 1.63; 95% CI = 1.01–2.62) but not with 7-day stroke severity (OR = 1.71; 95% CI = 0.97–3.01).

Conclusions

Pre-existing SVD burden, mainly driven by brain atrophy, negatively affects early and late clinical outcomes in anterior circulation ischemic stroke treated with endovascular therapy. Our results may help prognostic stratification of stroke patients treated with endovascular therapy.

Keywords

Small vessel disease CT Endovascular treatment Acute stroke Clinical outcomes 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, Lindley RI, O’Brien JT, Barkhof F, Benavente OR, Black SE, Brayne C, Breteler M, Chabriat H, Decarli C, de Leeuw FE, Doubal F, Duering M, Fox NC, Greenberg S, Hachinski V, Kilimann I, Mok V, Oostenbrugge Rv, Pantoni L, Speck O, Stephan BC, Teipel S, Viswanathan A, Werring D, Chen C, Smith C, van Buchem M, Norrving B, Gorelick PB, Dichgans M, STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1) (2013) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 12:822–838CrossRefGoogle Scholar
  2. 2.
    IST-3 collaborative group (2015) Association between brain imaging signs, early and late outcomes, and response to intravenous alteplase after acute ischaemic stroke in the third International Stroke Trial (IST-3): secondary analysis of a randomised controlled trial. Lancet Neurol 14:485–496CrossRefGoogle Scholar
  3. 3.
    Shi ZS, Loh Y, Liebeskind DS, Saer JL, Gonzalez NR, Tateshima S, Jahan R, Feng L, Vespa PM, Starkman S, Salamon N, Villablance JP, Ali LK, Ovbiagele B, Kim D, Viñuela F, Duckwiler GR (2012) Leukoaraiosis predicts parenchymal hematoma after mechanical thrombectomy in acute ischemic stroke. Stroke 43:1806–1811CrossRefGoogle Scholar
  4. 4.
    Henninger N, Lin E, Baker SP, Wakhloo AK, Takhtani D, Moonis M (2012) Leukoaraiosis predicts poor 90-day outcome after acute large cerebral artery occlusion. Cerebrovasc Dis 33:525–531CrossRefGoogle Scholar
  5. 5.
    Arba F, Leigh R, Inzitari D, Warach S, Luby M, Lees KR (2017a) On behalf of STIR/VISTA imaging collaboration. Blood-brain barrier leakage increases with small vessel disease in acute ischemic stroke. Neurology 89:2143–2150CrossRefGoogle Scholar
  6. 6.
    Klarenbeek P, van Oostenbrugge RJ, Rouhl RP, Knottnerus IL, Staals J (2013) Ambulatory blood pressure in patients with lacunar stroke: association with total MRI burden of cerebral small vessel disease. Stroke 44:2995–2999CrossRefGoogle Scholar
  7. 7.
    Staals J, Makin SD, Doubal FN, Dennis MS, Wardlaw JM (2014) Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology. 83:1228–1234CrossRefGoogle Scholar
  8. 8.
    Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Lancet. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group Alberta Stroke Programme Early CT Score. Lancet 355:1670–1674CrossRefGoogle Scholar
  9. 9.
    Menon BK, d’Esterre CD, Qazi EM, Almekhlafi M, Hahn L, Demchuk AM, Goyal M (2015) Radiology. Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke. Radiology. 275:510–520CrossRefGoogle Scholar
  10. 10.
    Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD, ESCAPE Trial Investigators (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372:1019–1030CrossRefGoogle Scholar
  11. 11.
    Wintermark M, Flanders AE, Velthuis B et al (2006) Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 37:979–985CrossRefGoogle Scholar
  12. 12.
    Van Swieten JC, Hijdra A, Koudstaal PJ, Van Gijn J (1990) Grading white matter lesions on CT and MRI: a simple scale. J Neurol Neurosurg Psychiatry 53:1080–1083CrossRefGoogle Scholar
  13. 13.
    Arba F, Inzitari D, Ali M, Warach SJ, Luby M, Lees KR (2017b) Small vessel disease and clinical outcomes after IV rt-PA treatment. Acta Neurol Scand 136:72–77CrossRefGoogle Scholar
  14. 14.
    Arba F, Mair G, Carpenter T, Sakka E, Sandercock PA, Lindley RI, Inzitari D, Wardlaw JM, IST-3 Trial Collaborators (2017c) Cerebral white matter hypoperfusion increases with small vessel disease burden. Data from the third international stroke trial. J Stroke Cerebrovasc Dis 26:1506–1513CrossRefGoogle Scholar
  15. 15.
    Fugate JE, Klunder AM, Kallmes DF (2013) What is meant by “TICI”? AJNR Am J Neuroradiol 34:1792–1797CrossRefGoogle Scholar
  16. 16.
    Berger C, Fiorelli M, Steiner T, Schäbitz WR̈, Bozzao L, Bluhmki E, Hacke W, von Kummer R̈ (2001) Hemorrhagic transformation of ischemic brain tissue: asymptomatic or symptomatic? Stroke. 32:1330–1335CrossRefGoogle Scholar
  17. 17.
    Kerr DM, Fulton RL, Lees KR, VISTA Collaborators (2012) Seven-day NIHSS is a sensitive outcome measure for exploratory clinical trials in acute stroke: evidence from the Virtual International Stroke Trials Archive. Stroke 43:1401–1403CrossRefGoogle Scholar
  18. 18.
    Pantoni L (2010) Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 9:689–701CrossRefGoogle Scholar
  19. 19.
    Palumbo V, Boulanger JM, Hill MD, Inzitari D, Buchan AM (2007) Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke. Neurology. 68:1020–1024CrossRefGoogle Scholar
  20. 20.
    Zhang J, Puri AS, Khan MA, Goddeau MA Jr, Henninger N (2014) Leukoaraiosis predicts a poor 90-day outcome after endovascular stroke therapy. AJNR. 35:2070–2075CrossRefGoogle Scholar
  21. 21.
    Atchaneeyasakul K, Leslie-Mazwi T, Donahue K, Giese AK, Rost NS (2017) White matter hyperintensity volume and outcome of mechanical thrombectomy with stentriever in acute ischemic stroke. Stroke. 48:2892–2894CrossRefGoogle Scholar
  22. 22.
    Dichgans M, Wardlaw J, Smith E, Zietemann V, Seshadri S, Sachdev P, Biessels GJ, Fazekas F, Benavente O, Pantoni L, de Leeuw FE, Norrving B, Matthews P, Chen C, Mok V, Düring M, Whiteley W, Shuler K, Alonso A, Black SE, Brayne C, Chabriat H, Cordonnier C, Doubal F, Duzel E, Ewers M, Frayne R, Hachinski V, Ikram MA, Jessen F, Jouvent E, Linn J, O'Brien J, van Oostenbrugge R, Malik R, Mazoyer B, Schmidt R, Sposato LA, Stephan B, Swartz RH, Vernooij M, Viswanathan A, Werring D, Abe K, Allan L, Arba F, Bae HJ, Bath PMW, Bordet R, Breteler M, Choi S, Deary I, DeCarli C, Ebmeier K, Feng L, Greenberg SM, Ihara M, Kalaria R, Kim SY, Lim JS, Lindley RI, Mead G, Murray A, Quinn T, Ritchie C, Sacco R, al-Shahi Salman R, Sprigg N, Sudlow C, Thomas A, van Boxtel M, van der Grond J, van der Lugt A, Yang YH, ETACOHORTS Consortium (2016) MMETACOHORTS for the study of vascular disease and its contribution to cognitive decline and neurodegeneration: an initiative of the joint programme for neurodegenerative disease research. Alzheimers Dement 12:1235–1249CrossRefGoogle Scholar
  23. 23.
    Pini L, Pievani M, Bocchetta M, Altomare D, Bosco P, Cavedo E, Galluzzi S, Marizzoni M, Frisoni GB (2016) Brain atrophy in Alzheimer’s disease and aging. Ageing Res Rev 30:25–48CrossRefGoogle Scholar
  24. 24.
    Dickie DA, Valdés Hernández MDC, Makin SD et al (2018) The brain health index: towards a combined measure of neurovascular and neurodegenerative structural brain injury. Int J Stroke 13:849–856CrossRefGoogle Scholar
  25. 25.
    Gilberti N, Gamba M, Premi E, Costa A, Vergani V, Delrio I, Spezi R, Dikran M, Frigerio M, Gasparotti R, Pezzini A, Padovani A, Magoni M (2017) Leukoaraiosis is a predictor of futile recanalization in acute ischemic stroke. J Neurol 264:448–452CrossRefGoogle Scholar
  26. 26.
    Shi ZS, Liebeskind DS, Xiang B, Ge SG, Feng L, Albers GW, Budzik R, Devlin T, Gupta R, Jansen O, Jovin TG, Killer-Oberpfalzer M, Lutsep HL, Macho J, Nogueira RG, Rymer M, Smith WS, Wahlgren N, Duckwiler GR, Multi MERCI, TREVO, and TREVO 2 Investigators (2014) Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes. Stroke. 45:1977–1984CrossRefGoogle Scholar
  27. 27.
    Østergaard L, Jespersen SN, Mouridsen K, Mikkelsen IK, Jonsdottír KÝ, Tietze A, Blicher JU, Aamand R, Hjort N, Iversen NK, Cai C, Hougaard KD, Simonsen CZ, von Weitzel-Mudersbach P, Modrau B, Nagenthiraja K, Ribe LR, Hansen MB, Bekke SL, Dahlman MG, Puig J, Pedraza S, Serena J, Cho TH, Siemonsen S, Thomalla G, Fiehler J, Nighoghossian N, Andersen G (2013) The role of the cerebral capillaries in acute ischemic stroke: the extended penumbra model. J Cereb Blood Flow Metab 33:635–648CrossRefGoogle Scholar
  28. 28.
    Ter Telgte A, van Leijsen EMC, Wiegertjes K, Klijn CJM, Tuladhar AM, de Leeuw FE (2018) Cerebral small vessel disease: from a focal to a global perspective. Nat Rev Neurol 14:387–398CrossRefGoogle Scholar
  29. 29.
    Eilaghi A, Brooks J, d’Esterre C, Zhang L, Swartz RH, Lee TY, Aviv RI (2013) Reperfusion is a stronger predictor of good clinical outcome than recanalization in ischemic stroke. Radiology. 269:240–248CrossRefGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Geriatric DepartmentCareggi University HospitalFlorenceItaly
  2. 2.NEUROFARBA DepartmentUniversity of FlorenceFlorenceItaly
  3. 3.Neurovascular Interventional UnitCareggi University HospitalFlorenceItaly

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