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Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke.
Cerebrovasc Dis. 2020; 49(4):419-426.CD

Abstract

INTRODUCTION

White matter hyperintensity (WMH) burden is a critically important cerebrovascular phenotype related to the diagnosis and prognosis of acute ischemic stroke. The effect of WMH burden on functional outcome in large vessel occlusion (LVO) stroke has only been sparsely assessed, and direct LVO and non-LVO comparisons are currently lacking.

MATERIAL AND METHODS

We reviewed acute ischemic stroke patients admitted between 2009 and 2017 at a large healthcare system in the USA. Patients with LVO were identified and clinical characteristics, including 90-day functional outcomes, were assessed. Clinical brain MRIs obtained at the time of the stroke underwent quantification of WMH using a fully automated algorithm. The pipeline incorporated automated brain extraction, intensity normalization, and WMH segmentation.

RESULTS

A total of 1,601 acute ischemic strokes with documented 90-day mRS were identified, including 353 (22%) with LVO. Among those strokes, WMH volume was available in 1,285 (80.3%) who had a brain MRI suitable for WMH quantification. Increasing WMH volume from 0 to 4 mL, age, female gender, a number of stroke risk factors, presence of LVO, and higher NIHSS at presentation all decreased the odds for a favorable outcome. Increasing WMH above 4 mL, however, was not associated with decreasing odds of favorable outcome. While WMH volume was associated with functional outcome in non-LVO stroke (p = 0.0009), this association between WMH and functional status was not statistically significant in the complete case multivariable model of LVO stroke (p = 0.0637).

CONCLUSION

The burden of WMH has effects on 90-day functional outcome after LVO and non-LVO strokes. Particularly, increases from no measurable WMH to 4 mL of WMH correlate strongly with the outcome. Whether this relationship of increasing WMH to worse outcome is more pronounced in non-LVO than LVO strokes deserves additional investigation.

Authors+Show Affiliations

Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA, christoph.griessenauer@gmail.com. Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria, christoph.griessenauer@gmail.com.Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.Biostatistics Core, Geisinger, Danville, Pennsylvania, USA.Biostatistics Core, Geisinger, Danville, Pennsylvania, USA.Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.Department of Neurology, Geisinger, Danville, Pennsylvania, USA.Department of Molecular and Functional Genomics, Geisinger, Danville, Pennsylvania, USA.Department of Molecular and Functional Genomics, Geisinger, Danville, Pennsylvania, USA. Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia, USA.Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA. Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32694259

Citation

Griessenauer, Christoph Johannes, et al. "Effects of White Matter Hyperintensities On 90-Day Functional Outcome After Large Vessel and Non-Large Vessel Stroke." Cerebrovascular Diseases (Basel, Switzerland), vol. 49, no. 4, 2020, pp. 419-426.
Griessenauer CJ, McPherson D, Berger A, et al. Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke. Cerebrovasc Dis. 2020;49(4):419-426.
Griessenauer, C. J., McPherson, D., Berger, A., Cuiper, P., Sofoluke, N., Adams, M. D., Kunaprayoon, S., Zand, R., Li, J., Abedi, V., Goren, O., Schirmer, C. M., Donahue, K., Nardin, M., Giese, A. K., Schirmer, M. D., Rost, N. S., & Hendrix, P. (2020). Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke. Cerebrovascular Diseases (Basel, Switzerland), 49(4), 419-426. https://doi.org/10.1159/000509071
Griessenauer CJ, et al. Effects of White Matter Hyperintensities On 90-Day Functional Outcome After Large Vessel and Non-Large Vessel Stroke. Cerebrovasc Dis. 2020;49(4):419-426. PubMed PMID: 32694259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke. AU - Griessenauer,Christoph Johannes, AU - McPherson,David, AU - Berger,Andrea, AU - Cuiper,Ping, AU - Sofoluke,Nelson, AU - Adams,Matthew D, AU - Kunaprayoon,Saran, AU - Zand,Ramin, AU - Li,Jiang, AU - Abedi,Vida, AU - Goren,Oded, AU - Schirmer,Clemens M, AU - Donahue,Kathleen, AU - Nardin,Marco, AU - Giese,Anne-Karin, AU - Schirmer,Markus D, AU - Rost,Natalia S, AU - Hendrix,Philipp, Y1 - 2020/07/21/ PY - 2020/03/18/received PY - 2020/06/02/accepted PY - 2021/07/21/pmc-release PY - 2020/7/23/pubmed PY - 2020/7/23/medline PY - 2020/7/23/entrez KW - Hyperintensity KW - Large vessel occlusion KW - Outcome KW - Stroke KW - White matter SP - 419 EP - 426 JF - Cerebrovascular diseases (Basel, Switzerland) JO - Cerebrovasc Dis VL - 49 IS - 4 N2 - INTRODUCTION: White matter hyperintensity (WMH) burden is a critically important cerebrovascular phenotype related to the diagnosis and prognosis of acute ischemic stroke. The effect of WMH burden on functional outcome in large vessel occlusion (LVO) stroke has only been sparsely assessed, and direct LVO and non-LVO comparisons are currently lacking. MATERIAL AND METHODS: We reviewed acute ischemic stroke patients admitted between 2009 and 2017 at a large healthcare system in the USA. Patients with LVO were identified and clinical characteristics, including 90-day functional outcomes, were assessed. Clinical brain MRIs obtained at the time of the stroke underwent quantification of WMH using a fully automated algorithm. The pipeline incorporated automated brain extraction, intensity normalization, and WMH segmentation. RESULTS: A total of 1,601 acute ischemic strokes with documented 90-day mRS were identified, including 353 (22%) with LVO. Among those strokes, WMH volume was available in 1,285 (80.3%) who had a brain MRI suitable for WMH quantification. Increasing WMH volume from 0 to 4 mL, age, female gender, a number of stroke risk factors, presence of LVO, and higher NIHSS at presentation all decreased the odds for a favorable outcome. Increasing WMH above 4 mL, however, was not associated with decreasing odds of favorable outcome. While WMH volume was associated with functional outcome in non-LVO stroke (p = 0.0009), this association between WMH and functional status was not statistically significant in the complete case multivariable model of LVO stroke (p = 0.0637). CONCLUSION: The burden of WMH has effects on 90-day functional outcome after LVO and non-LVO strokes. Particularly, increases from no measurable WMH to 4 mL of WMH correlate strongly with the outcome. Whether this relationship of increasing WMH to worse outcome is more pronounced in non-LVO than LVO strokes deserves additional investigation. SN - 1421-9786 UR - https://www.unboundmedicine.com/medline/citation/32694259/Effects_of_White_Matter_Hyperintensities_on_90_Day_Functional_Outcome_after_Large_Vessel_and_Non_Large_Vessel_Stroke_ L2 - https://www.karger.com?DOI=10.1159/000509071 DB - PRIME DP - Unbound Medicine ER -
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