title: Leukoaraiosis predicts parenchymal hematoma after mechanical thrombectomy in acute ischemic stroke.
abstract: OBJECTIVE
  The purpose of this study was to determine whether leukoaraiosis (LA) predicts hemorrhagic transformation and poor outcome in patients with acute ischemic stroke treated by mechanical thrombectomy.
  
  
  METHODS
  We retrospectively analyzed patients with anterior circulation stroke treated with Merci devices and identified LA in the deep white matter (DWM) and periventricular white matter on the preintervention MR images. We dichotomized patients into those with moderate or severe LA in the DWM versus those without. Hemorrhage rates and outcomes were evaluated between 2 groups. We analyzed the association of moderate or severe LA with hemorrhagic transformation and poor outcome.
  
  
  RESULTS
  Twenty-six of 105 patients had moderate or severe LA in the DWM. Patients with moderate or severe LA in the DWM were older, had more severe neurological deficits and worse outcome, had higher rates of hemorrhagic transformation and parenchymal hematoma, but had equivalent rates of hemorrhagic infarct and subarachnoid hemorrhage when compared with those without. Patients with only periventricular LA did not have a higher rate of parenchymal hematoma. Moderate or severe LA in the DWM was an independent predictor of hemorrhagic transformation (OR, 3.4; P=0.019) and parenchymal hematoma (OR, 6.3; P=0.005). Patients with parenchymal hematoma were less often independent (modified Rankin Scale≤2, 3.8% versus 32.5%; P=0.003) and had greater in-hospital mortality (50% versus 10.4%; P<0.001).
  
  
  CONCLUSIONS
  Moderate or severe LA in the DWM increases the risk of parenchymal hematoma after Merci thrombectomy for patients with acute stroke. These findings require validation in a larger prospective study.
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. zhongsongshi@gmail.com
authors.forename: Zhong-Song
authors.initials: ZS
authors.lastname: Shi
authors.forename: Yince
authors.initials: Y
authors.lastname: Loh
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Gonzalez
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tateshima
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Paul M
authors.initials: PM
authors.lastname: Vespa
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Villablance
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.forename: Fernando
authors.initials: F
authors.lastname: Viñuela
authors.forename: Gary R
authors.initials: GR
authors.lastname: Duckwiler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D049292:Leukoaraiosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy