医学
四分位数
置信区间
优势比
冲程(发动机)
内科学
脑出血
高强度
前瞻性队列研究
外科
心脏病学
磁共振成像
放射科
机械工程
工程类
蛛网膜下腔出血
作者
Gregoire Boulouis,Nicolas Bricout,Wagih Benhassen,Marc Ferré,Guillaume Turc,Martin Bretzner,Joseph Benzakoun,Pierre Seners,Thomas Personnic,Laurence Legrand,Denis Trystram,Christine Rodriguez-Régent,Andreas Charidimou,Natalia S. Rost,Serge Bracard,Charlotte Cordonnier,Catherine Oppenheim,Olivier Naggara,Hilde Henon
出处
期刊:Neurology
[Ovid Technologies (Wolters Kluwer)]
日期:2019-09-13
卷期号:93 (16): e1498-e1506
被引量:44
标识
DOI:10.1212/wnl.0000000000008317
摘要
Introduction To determine the influence of white matter hyperintensity (WMH) burden on functional outcome, rate of symptomatic intracerebral hemorrhage (sICH), and procedural success in patients with acute ischemic stroke (AIS) treated by mechanical thrombectomy (MT) with current stentriever/aspiration devices. Methods Patients with AIS due to large vessel occlusion (LVO) from the Thrombectomie des Artères Cérébrales (THRACE) trial and prospective cohorts from 2 academic comprehensive stroke centers treated with MT were pooled and retrospectively analyzed. WMH volumes were obtained by semiautomated planimetric segmentation and tested in association with the rate of favorable outcome (90-day functional independence), substantial recanalization after MT, and sICH. Results A total of 496 participants were included between 2015 and 2018 (50% female, mean age 68.1 ± 15.0 years). Overall, 434 (88%) patients presented with detectable WMH (mean ± SD 4.93 ± 7.7). Patients demonstrated increasingly worse outcomes with increasing WMH volumes (odds ratio [aOR]1.05 per 1-cm 3 increase for unfavorable outcome, 95% confidence interval [CI] 1.01–1.06, p = 0.014). Fifty-seven percent of patients in the first quartile of WMH volume vs 28% in the fourth quartile demonstrated favorable outcome ( p < 0.001). WMH severity was not associated with sICH rate (aOR 0.99, 95% CI 0.93–1.04, p = 0.66), nor did it influence recanalization success (aOR 0.99, 95% CI 0.96–1.02, p = 0.84). Conclusion Our study provides evidence that in patients with AIS due to LVO and high burden of WMH as assessed by pretreatment MRI, the safety and efficacy profiles of MT are similar to those in patients with lower WMH burden and confirms that they are at higher risk of unfavorable outcome. Because more than a quarter of patients in the highest WMH quartile experienced favorable 3 months outcome, WMH burden may not be a good argument to deny MT. ClinicalTrials.gov Identifier NCT01062698.
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