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Tateishi Y, Wisco D, Aoki J, et al. Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke. Interv Neurol. 2015;3(1):48-55doi: 10.1159/000369835.
Tateishi, Y., Wisco, D., Aoki, J., George, P., Katzan, I., Toth, G., Hui, F., Hussain, M. S., & Uchino, K. (2015). Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke. Interventional neurology, 3(1), 48-55. https://doi.org/10.1159/000369835
Tateishi, Yohei, et al. "Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke." Interventional neurology vol. 3,1 (2015): 48-55. doi: https://doi.org/10.1159/000369835
Tateishi Y, Wisco D, Aoki J, George P, Katzan I, Toth G, Hui F, Hussain MS, Uchino K. Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke. Interv Neurol. 2015 Jan;3(1):48-55. doi: 10.1159/000369835. PMID: 25999992; PMCID: PMC4436528.
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Interv Neurol. 2015 Jan;3(1):48-55. doi: 10.1159/000369835.

Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke.

Interventional neurology

Yohei Tateishi, Dolora Wisco, Junya Aoki, Pravin George, Irene Katzan, Gabor Toth, Ferdinand Hui, Muhammad S Hussain, Ken Uchino

Affiliations

  1. Cerebrovascular Center, Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki City, Tokyo, Japan ; Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
  2. Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
  3. Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.

PMID: 25999992 PMCID: PMC4436528 DOI: 10.1159/000369835

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).

CONCLUSION: Patients with large preintervention DWI-DWM lesions may be poor candidates for endovascular therapy.

Keywords: Acute stroke; Deep white matter; Endovascular therapy; Magnetic resonance imaging; Outcome

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