title: Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke.
abstract: OBJECTIVE
  This study investigated whether large ischemic lesions in the deep white matter (DWM) on pretreatment diffusion-weighted MRI (DWI) predict futile recanalization.
  
  
  METHODS
  Consecutive acute stroke patients with anterior circulation ischemia who underwent successful arterial recanalization with thrombolysis in cerebral infarction grade 2b or 3 were enrolled. A large DWI-DWM lesion was defined as a hyperintense lesion in the DWM on initial DWI, located mainly between the anterior and posterior horns of the lateral ventricle. The Alberta Stroke Program Early CT score on CT and DWI and stroke volume on initial DWI were recorded. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score. Futile recanalization was defined as a 30-day modified Rankin scale score of 3-6 despite successful recanalization. Univariate and multivariate regression analyses were performed to identify predictors of futile recanalization.
  
  
  RESULTS
  In 35 of 46 patients (76%) with successful recanalization, futile recanalization was observed in 20 patients (57%). Patients with futile recanalization were older (median age 74 vs. 58 years; p = 0.053), had higher initial NIHSS scores (median 17 vs. 9; p = 0.042), and a higher prevalence of large DWI-DWM lesions (45 vs. 9%; p = 0.022). Logistic regression analysis showed that a large DWI-DWM lesion was an independent predictor of futile recanalization (OR 13.97; 95% CI 1.32-147.73; p = 0.028).
  
  
  CONCLUSIONS
  Patients with large preintervention DWI-DWM lesions may be poor candidates for endovascular therapy.
authors.affiliation: Cerebrovascular Center, Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Tokyo, Japan ; Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tateishi
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Dolora
authors.initials: D
authors.lastname: Wisco
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Pravin
authors.initials: P
authors.lastname: George
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Katzan
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Gabor
authors.initials: G
authors.lastname: Toth
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Hui
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Hussain
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
keywords: Acute stroke; Deep white matter; Endovascular therapy; Magnetic resonance imaging; Outcome