title: Leukoaraiosis is a predictor of futile recanalization in acute ischemic stroke.
abstract: Futile recanalization occurs when successful recanalization fails to improve clinical outcome in acute ischemic stroke patients. Predictors of futile recanalization are still debated and may help in selecting patients for reperfusion strategies. We aim to determine whether leukoaraiosis may be useful in predicting futile recanalization in acute ischemic stroke patients treated by endovascular mechanical thrombectomy. We included in the analysis patients with acute ischemic stroke due to anterior circulation large vessel occlusion undergoing endovascular mechanical thrombectomy obtaining complete vessel recanalization. Demographics, vascular risk factors, baseline National Institutes of Health Stroke Scale score, time from symptoms onset to recanalization, Alberta Stroke Program Early CT Score, and leukoaraiosis graded on a 4-point van Swieten scale were collected. We dichotomized patients into those with moderate-severe leukoaraiosis (2-4) versus those with absent-slight leukoaraiosis (0, 1). Outcome measures were symptomatic intracranial hemorrhage, and modified Rankin scale score at 90 days. The relationships among radiological parameters and clinical data with outcome measures were studied with univariate and multivariable analyses. Sixty-eight patients were identified. Recanalization was futile in 32.4% of cases. On multivariable logistic regression analysis, the presence of moderate-severe LA was independent predictors of FR (P = 0.01). Furthermore, higher NIHSS score at baseline (P < 0.01) end endovascular mechanical thrombectomy alone treatment (P < 0.01) resulted associated with futile recanalization. Our results showed that the presence of moderate-severe leukoaraiosis is associated with poor outcome in recanalized patients.
authors.affiliation: Stroke Unit, U.O. Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy. nicgilbe@gmail.com.
authors.forename: Nicola
authors.identifier: http://orcid.org/0000-0002-0274-7664
authors.initials: N
authors.lastname: Gilberti
authors.affiliation: Stroke Unit, U.O. Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gamba
authors.affiliation: Stroke Unit, U.O. Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Premi
authors.affiliation: Stroke Unit, U.O. Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Costa
authors.affiliation: Stroke Unit, U.O. Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Vergani
authors.affiliation: Stroke Unit, U.O. Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Ilenia
authors.initials: I
authors.lastname: Delrio
authors.affiliation: Stroke Unit, U.O. Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Spezi
authors.affiliation: U.O. Neuroradiologia, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Mardighian
authors.initials: M
authors.lastname: Dikran
authors.affiliation: U.O. Neuroradiologia, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Frigerio
authors.affiliation: U.O. Neuroradiologia, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gasparotti
authors.affiliation: Clinica Neurologica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzini
authors.affiliation: Clinica Neurologica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
authors.affiliation: Stroke Unit, U.O. Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Magoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000150:complications* / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D017131:Thrombectomy; D017211:Treatment Failure
keywords: Acute ischemic stroke; Endovascular thrombectomy; Leukoaraiosis; Stroke treatment