Title
Leukoaraiosis predicts cortical infarct volume after distal middle cerebral artery occlusion
UMMS Affiliation
Department of Neurology
Publication Date
2014-03-01
Document Type
Article
Subjects
Aged; Aged, 80 and over; Cerebral Angiography; Endovascular Procedures; Female; Humans; Image Processing, Computer-Assisted; Infarction, Middle Cerebral Artery; Leukoaraiosis; Male; Middle Aged; Neuroimaging; Predictive Value of Tests; ROC Curve; Recovery of Function; Regression Analysis; Retrospective Studies; Risk Factors; Thrombolytic Therapy; Tomography, X-Ray Computed; Treatment Outcome
Disciplines
Nervous System Diseases | Neurology
Abstract
BACKGROUND AND PURPOSE: Leukoaraiosis (LA) predominantly affects the subcortical white matter, but mounting evidence suggests an association with cortical microvascular dysfunction and potentially decreased cortical ischemic tolerance. Thus, we sought to assess whether preexisting LA is predictive of the cortical infarct volume after middle cerebral artery branch occlusion and whether it relates to a worse outcome.
METHODS: We analyzed data from 117 consecutive patients with middle cerebral artery branch occlusion as documented by admission computed tomography angiography. Baseline clinical, laboratory, and outcome data, as well as final cortical infarct volumes, were retrospectively analyzed from a prospectively collected database. LA severity was assessed on admission computed tomography using the van Swieten scale grading the supratentorial white matter hypoattenuation. Infarct volume predicting a favorable 90-day outcome (modified Rankin Scale score≤2) was determined by receiver operating characteristic curves. Multivariable linear and logistic regression analyses were used to identify independent predictors of the final infarct volume and outcome.
RESULTS: Receiver operating characteristic curve analyses indicated that a final infarct volume of ≤27 mL best predicted a favorable 90-day outcome. Severe LA (odds ratio, 11.231; 95% confidence interval, 2.526-49.926; P=0.001) was independently associated with infarct volume>27 mL. Severe LA (odds ratio, 3.074; 95% confidence interval, 1.055-8.961; P=0.040) and infarct volume>27 mL (odds ratio, 9.156; 95% confidence interval, 3.191-26.270; P < .0001) were independent predictors of a poor 90-day outcome (modified Rankin Scale, 3-6).
CONCLUSIONS: The presence of severe, subcortical LA contributes to larger cortical infarct volumes and worse functional outcomes adding to the notion that the brain is negatively affected beyond LA's macroscopic boundaries.
Keywords
cerebral small vessel diseases, leukoaraiosis, stroke, stroke, lacunar
DOI of Published Version
10.1161/STROKEAHA.113.002855
Source
Stroke. 2014 Mar;45(3):689-95. doi: 10.1161/STROKEAHA.113.002855. Epub 2014 Feb 12. Link to article on publisher's site
Journal/Book/Conference Title
Stroke; a journal of cerebral circulation
Related Resources
PubMed ID
24523039
Repository Citation
Henninger, Nils; Khan, Muhib; Zhang, Jiaying; Moonis, Majaz; and Goddeau, Richard P., "Leukoaraiosis predicts cortical infarct volume after distal middle cerebral artery occlusion" (2014). Neurology Publications and Presentations. 435.
https://escholarship.umassmed.edu/neuro_pp/435
Comments
First author Nils Henninger is a doctoral student in the Millennium PhD Program (MPP) in the Graduate School of Biomedical Sciences (GSBS) at UMass Medical School.