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Leukoaraiosis is a predictor of futile recanalization in acute ischemic stroke

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Abstract

Futile recanalization occurs when successful recanalization fails to improve clinical outcome in acute ischemic stroke patients. Predictors of futile recanalization are still debated and may help in selecting patients for reperfusion strategies. We aim to determine whether leukoaraiosis may be useful in predicting futile recanalization in acute ischemic stroke patients treated by endovascular mechanical thrombectomy. We included in the analysis patients with acute ischemic stroke due to anterior circulation large vessel occlusion undergoing endovascular mechanical thrombectomy obtaining complete vessel recanalization. Demographics, vascular risk factors, baseline National Institutes of Health Stroke Scale score, time from symptoms onset to recanalization, Alberta Stroke Program Early CT Score, and leukoaraiosis graded on a 4-point van Swieten scale were collected. We dichotomized patients into those with moderate–severe leukoaraiosis (2–4) versus those with absent-slight leukoaraiosis (0, 1). Outcome measures were symptomatic intracranial hemorrhage, and modified Rankin scale score at 90 days. The relationships among radiological parameters and clinical data with outcome measures were studied with univariate and multivariable analyses. Sixty-eight patients were identified. Recanalization was futile in 32.4% of cases. On multivariable logistic regression analysis, the presence of moderate–severe LA was independent predictors of FR (P = 0.01). Furthermore, higher NIHSS score at baseline (P < 0.01) end endovascular mechanical thrombectomy alone treatment (P < 0.01) resulted associated with futile recanalization. Our results showed that the presence of moderate–severe leukoaraiosis is associated with poor outcome in recanalized patients.

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Authors and Affiliations

  1. Stroke Unit, U.O. Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy

    Nicola Gilberti, Massimo Gamba, Enrico Premi, Angelo Costa, Veronica Vergani, Ilenia Delrio, Raffaella Spezi & Mauro Magoni

  2. U.O. Neuroradiologia, Università degli Studi di Brescia, Brescia, Italy

    Mardighian Dikran, Michele Frigerio & Roberto Gasparotti

  3. Clinica Neurologica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy

    Alessandro Pezzini & Alessandro Padovani

Authors
  1. Nicola Gilberti
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  2. Massimo Gamba
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  3. Enrico Premi
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  4. Angelo Costa
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  5. Veronica Vergani
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  6. Ilenia Delrio
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  7. Raffaella Spezi
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  8. Mardighian Dikran
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  9. Michele Frigerio
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  10. Roberto Gasparotti
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  11. Alessandro Pezzini
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  12. Alessandro Padovani
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  13. Mauro Magoni
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Correspondence to Nicola Gilberti.

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The authors have no conflicts of interest to declare.

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An approval by an ethics committee was not applicable, because this was an observational study.

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Gilberti, N., Gamba, M., Premi, E. et al. Leukoaraiosis is a predictor of futile recanalization in acute ischemic stroke. J Neurol 264, 448–452 (2017). https://doi.org/10.1007/s00415-016-8366-y

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  • DOI: https://doi.org/10.1007/s00415-016-8366-y

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