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Mistry EA, Mistry AM, Mehta T, Arora N, Starosciak AK, La Rosa FDLR, Siegler JE, Kasner SE, Chitale R, Fusco M, Froehler M, Yaghi S, Schrag M, Khatri P. White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2020; 41:639-644. [PMID: 32165366 DOI: 10.3174/ajnr.a6478] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/31/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The increased severity of white matter disease is associated with worse outcomes and an increased rate of intracerebral hemorrhage in patients with ischemic stroke undergoing thrombolytic treatment. However, whether white matter disease is associated with outcomes in patients undergoing endovascular treatment remains unclear. MATERIALS AND METHODS In this prespecified exploratory analysis of our prospective multi-institutional study that enrolled consecutive adult patients with anterior circulation ischemic stroke undergoing endovascular treatment from November 2017 to September 2018, we compared the following outcomes between patients with none-to-minimal (van Swieten score, 0-2) and moderate-to-severe (van Swieten score, 3-4) white matter disease using logistic regression: 90-day mRS 3-6, death, intracerebral hemorrhage, successful recanalization, and early neurologic recovery. RESULTS Of the 485 patients enrolled in the Blood Pressure after Endovascular Stroke Therapy (BEST) study, 389 had white matter disease graded (50% women; median age, 68 years; range, 58-79 years). A van Swieten score of 3-4 (n = 74/389, 19%) was associated with a higher rate of 90-day mRS of 3-6 (45% versus 18%; adjusted OR, 2.73; 95% CI, 1.34-5.93; P = .008). Although the death rate was higher in patients with van Swieten scores of 3-4 (26% versus 15%), the adjusted likelihood was not significantly different (adjusted OR, 1.14; 95% CI, 0.56-2.26; P = .710). Ordered regression revealed a shift toward worse mRS scores with increasing van Swieten scores (adjusted common OR, 3.04; 95% CI, 1.93-4.84; P < .001). No associations between white matter disease severity and intracerebral hemorrhage, successful recanalization, and early neurologic recovery were observed. CONCLUSIONS Moderate-to-severe white matter disease is associated with worse outcomes in patients undergoing endovascular treatment without a significant increase in hemorrhagic complications. Studies comparing patients with and without endovascular treatment are necessary to determine whether the benefit of endovascular treatment is attenuated with greater white matter disease.
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Affiliation(s)
- E A Mistry
- From the Departments of Neurology (E.A.M., M.S.) and
| | - A M Mistry
- Neurosurgery (A.M.M., R.C., M. Fusco), and
| | - T Mehta
- Department of Neurology and Neurosurgery (T.M.), University of Minnesota, Minneapolis, Minnesota
| | - N Arora
- Department of Neurology (N.A.), University of Missouri, Columbia, Missouri
| | - A K Starosciak
- Baptist Health Neuroscience Center (A.K.S., F.D.L.R.L.R.), Miami, Florida
| | - F D L R La Rosa
- Baptist Health Neuroscience Center (A.K.S., F.D.L.R.L.R.), Miami, Florida
| | - J E Siegler
- Department of Neurology (J.E.S., S.E.K.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - S E Kasner
- Department of Neurology (J.E.S., S.E.K.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - R Chitale
- Neurosurgery (A.M.M., R.C., M. Fusco), and
| | - M Fusco
- Neurosurgery (A.M.M., R.C., M. Fusco), and
| | - M Froehler
- Cerebrovascular Program (M. Froehler), Vanderbilt University Medical Center, Nashville, Tennessee
| | - S Yaghi
- New York University Langone Health (S.Y.), Brooklyn, New York
| | - M Schrag
- From the Departments of Neurology (E.A.M., M.S.) and
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Froehler M, Aziz-Sultan M, Jahan R, Klucznik R, Saver J, Zaidat O, Yavagal D, Mueller-Kronast N. O-024 Systems of Care Efficiency and Interhospital Transfer Delays in the STRATIS Registry. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zaidat O, Liebeskind D, Jahan R, Froehler M, Aziz-Sultan M, Klucznik R, Saver J, Yavagal D, Mueller-Kronast N. O-005 Influence of Balloon, Conventional, or Distal Catheters on Angiographic and Technical Outcomes in STRATIS. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Castonguay A, Nogueira R, English J, Satti S, Farid H, Veznedaroglu E, Binning M, Puri A, Vora N, Budzik R, Dabus G, Linfante I, Janardhan V, Alshekhlee A, Abraham M, Edgell R, Taqi M, El Khoury R, Mokin M, Mokin M, Majjhoo A, Kabbani M, Froehler M, Finch I, Ansari S, Novakovic R, Nguyen T, Zaidat O. O-004 Analysis of M2 Occlusions within TREVO Acute Ischemic Stroke (TRACK) stent-retriever Thrombectomy Registry. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zaidat O, Castonguay A, Gupta R, Sun C, Martin C, Holloway W, Mueller-Kronast N, English J, Linfante I, Dabus G, Malisch T, Marden F, Bozorgchami H, Xavier A, Rai A, Froehler M, Badruddin A, Nguyen T, Taqi M, Abraham M, Janardhan V, Shaltoni H, Novakovic R, Yoo A, Abou-Chebl A, Chen P, Britz G, Kaushal R, Nanda A, Nogueira R. O-004 the first pass effect: a new measure for stroke thrombectomy devices. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Froehler M. E-144 use of the pipeline flex for treatment of a pediatric giant intracranial aneurysm. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Froehler M. E-143 pediatric cerebrovascular access systems. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Froehler M. E-145 variable ophthalmic hemodynamics in children with retinoblastoma undergoing intra-arterial chemotherapy. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fusco M, Chua M, Froehler M, Thomas A, Ogilvy C. E-130 pre-treatment prediction of aneurysm recanalization following endovascular coiling: a single-center modification of a validated prediction score. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zaidat O, Castonguay A, Nogueira R, Ramakrishnan P, Haussen D, Lima A, English J, Farid H, Veznedaroglu E, Binning M, Puri A, Hou S, Janardhan V, Vora N, Budzik R, Alshekhlee A, Abraham M, Edgell R, Taqi M, Lin E, Khoury R, Mokin M, Majjhoo A, Kabbani M, Froehler M, Finch I, Prabhakaran S, Novakovic R, Nguyen T, Wesley J. O-008 final revascularization and clinical outcome results from the multicenter trevo stent-retriever acute stroke (track) post-marketing registry. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Froehler M, Ebersole K, Duckworth E, Arthur A, Ross I, Hanel R, Moran C. E-146 initial u. s. experience with the pipeline flex prior to fda approval. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Castonguay A, Zaidat O, Nogueira R, Ramakrishnan P, Haussen D, Lima A, English J, Farid H, Veznedaroglu E, Binning M, Puri A, Hou S, Janardhan V, Vora N, Budzik R, Alshekhlee A, Abraham M, Edgell R, Taqi M, Lin E, Khoury R, Mokin M, Majjhoo A, Kabbani M, Froehler M, Finch I, Prabhakaran S, Novakovic R, Nguyen T. E-055 analysis of a mr clean-like group in the multicenter track registry. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Froehler M, Espaillat K. P-001 evaluation of transfer times for emergent stroke patients from regional centers to a comprehensive center. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gilchrist E, Burks B, Espaillat K, Fortenberry T, Baggett S, Kearney M, Goggins B, He L, Mocco J, Froehler M. E-076 improvement of patient care, quality and research through an automated cerebrovascular data collection (acdc). J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ladner T, He L, Pruthi S, Day M, Desai A, Jordan L, Froehler M. O-039 diameters of large vessels in children and compatibility with adult interventional stroke devices: children are not little adults. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Linfante I, Dabus G, Starosciak A, Castonguay A, Gupta R, Sun C, Martin C, Holloway W, Mueller-Kronast N, English J, Malisch T, Marden F, Bozorgchami H, Xavier A, Rai A, Froehler M, Badruddin A, Nguyen T, Taqi M, Abraham M, Janardhan V, Shaltoni H, Novakovic R, Yoo A, Zaidat O. O-032 Predictors of Poor Outcomes Despite Successful Recanalization in Patients with Acute Ischemic Stroke. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zaidat O, Castonguay A, Veznedaroglu E, Binning M, Alshekhlee A, Abraham M, Mehta S, El Khoury R, Majjhoo A, Lin E, Kabbani M, Froehler M, Nguyen T. P-021 TREVO Stent-Retriever Acute Stroke (TRACK) Post-marketing Registry: Interim Revascularization and Clinical Outcome Results Compared to TREVO-2 and NASA Registry. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Castonguay A, Zaidat O, Novakovic R, Gupta R, Sun C, Martin C, Holloway W, Mueller-Kronast N, English J, Linfante I, Dabus G, Malisch T, Marden F, Bozorgchami H, Xavier A, Rai A, Froehler M, Badruddin A, Nguyen T, Taqi M, Abraham M, Janardhan V, Shaltoni H, Yoo A, Abou-Chebl A. E-040 Analysis of the SPAN-100 Index as a Predictor of Clinical Outcome in the Post-Marketing North American SOLITAIRE Stent-Retriever Acute Stroke Registry. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nogueira R, Castonguay A, Gupta R, Sun C, Martin C, Holloway W, Mueller-Kronast N, English J, Linfante I, Dabus G, Malisch T, Bozorgchami H, Xavier A, Rai A, Froehler M, Badruddin A, Nguyen T, Taqi M, Abraham M, Janardhan V, Shaltoni H, Yoo A, Abou-Chebl A, Chen P, Zaidat O. O-003 IMS3 Like Subgroup Analysis in the North American SOLITAIRE Stent-Retriever Acute Stroke Registry: Abstract O-003 Table 1. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zaidat O, Castonguay A, Gupta R, Sun C, Martin C, Mueller-Kronast N, Holloway W, English J, Linfante I, Dabus G, Malisch T, Marden F, Bozorgchami H, Xavier A, Rai A, Froehler M, Badruddin A, Nguyen T, Taqi M, Abraham M, Janardhan V, Shaltoni H, Yoo A, Abou-Chebl A, Chen P. E-039 North American Solitaire Stent-Retriever Acute Stroke Registry: Post-Marketing Revascularisation and Clinical Outcome Results As Compared to the SWIFT and TREVO-2 Clinical Trials. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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