title: Leukoaraiosis predicts a poor 90-day outcome after endovascular stroke therapy.
abstract: OBJECTIVE
  Leukoaraiosis is a common finding among patients with ischemic stroke and has been associated with poor stroke outcomes. Our aim was to ascertain whether the severity of pre-existing leukoaraiosis is associated with outcome in patients with acute ischemic stroke who are treated with endovascular stroke therapy.
  
  
  METHODS
  We retrospectively analyzed data from 129 consecutive, prospectively enrolled patients with stroke undergoing endovascular stroke therapy at a single tertiary care center between January 2006 and August 2013. Leukoaraiosis was assessed as supratentorial white matter hypoattenuation on admission head CT and graded as 0-2 (absent-to-moderate) versus 3-4 (severe) according to the van Swieten scale. We dichotomized the 90-day mRS into good (0-2 or return to baseline) versus poor (3-6) as the primary study outcome. Incremental multivariable logistic regression analyses were performed to identify independent predictors of a poor 90-day outcome.
  
  
  RESULTS
  In all multivariable models, severe leukoaraiosis was independently (P < .05) associated with a poor outcome at 90 days (fully adjusted model: OR, 6.37; 95% CI, 1.83-12.18; P = .004). The independent association between leukoaraiosis and a poor outcome remained when the analysis was restricted to patients who were alive at discharge (n = 87, P < .05). Last, among patients who were alive at discharge, those with severe leukoaraiosis had significantly less frequent improvement on the mRS from discharge to 90 days compared with patients with absent-to-moderate leukoaraiosis (P = .034).
  
  
  CONCLUSIONS
  The severity of pre-existing leukoaraiosis is independently associated with 90-day functional outcome in patients with stroke who underwent endovascular stroke therapy. These results highlight the need to further explore leukoaraiosis as a promising surrogate marker for poor outcome after endovascular stroke therapy to improve risk assessment, patient selection, and early prognostic accuracy.
authors.affiliation: From the Departments of Neurology (J.Z., N.H., R.P.G.).
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Radiology (A.S.P.) Neurosurgery (A.S.P.).
authors.forename: A S
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Department of Neurology (M.A.K.), Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.affiliation: From the Departments of Neurology (J.Z., N.H., R.P.G.).
authors.forename: R P
authors.initials: RP
authors.lastname: Goddeau
authors.affiliation: From the Departments of Neurology (J.Z., N.H., R.P.G.) Psychiatry (N.H.), University of Massachusetts Medical School, Worcester, Massachusetts nils.henninger@umassmed.edu.
authors.forename: N
authors.initials: N
authors.lastname: Henninger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome