Rastogi, Aarushi and Weissert, Robert and Bhaskar, Sonu Menachem Maimonides (2022) Leukoaraiosis severity and post-reperfusion outcomes in acute ischaemic stroke: A meta-analysis. ACTA NEUROLOGICA SCANDINAVICA, 145 (2). pp. 171-184. ISSN 0001-6314, 1600-0404
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Objectives Severity of leukoaraiosis may mediate outcomes after reperfusion therapy in acute ischaemic stroke (AIS) patients. However, the level of the association remains poorly understood. We performed a meta-analysis to investigate the impact of leukoaraiosis severity on functional outcome, survival, haemorrhagic complications, and procedural success in AIS patients treated with intravenous thrombolysis and/or endovascular thrombectomy. Materials and Methods PubMed, EMBASE and the Cochrane library were searched for studies on leukoaraiosis in AIS receiving reperfusion therapy. A random-effects meta-analysis was conducted for post-reperfusion outcomes in AIS patients with absent-to-mild leukoaraiosis and moderate-to-severe leukoaraiosis. The strength of association between moderate-to-severe leukoaraiosis and poor outcomes was quantified using odds ratios (OR). Results A total of 15 eligible studies involving 6460 patients (1451 with moderate-to-severe leukoaraiosis and 5009 with absent-to-mild leukoaraiosis) were included in the meta-analysis. Moderate-to-severe leukoaraiosis was significantly associated with poor 90-day functional outcome (OR 3.16; 95% confidence interval (CI) 2.69-3.72; p < .0001), 90-day mortality (OR 3.11; 95% CI 2.27-4.26; p < .0001) and increased risk of symptomatic intracerebral haemorrhage (OR 1.69; 95% CI 1.24-2.32; p = .001) after reperfusion therapy. Overall, no significant association of leukoaraiosis severity with haemorrhagic transformation (HT) and angiographic recanalization status were observed. However, subgroup analysis revealed a significant association of WML severity with HT in patients receiving EVT. Conclusion Leukoaraiosis is a useful prognostic biomarker in AIS. Patients with moderate-to-severe leukoaraiosis on baseline imaging are likely to have worse clinical and safety outcomes after reperfusion therapy.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | WHITE-MATTER LESIONS; SMALL VESSEL DISEASE; INTRACEREBRAL HEMORRHAGE; INFARCT VOLUME; THROMBOLYSIS; RISK; HYPERINTENSITIES; DEMENTIA; BURDEN; CT; acute ischaemic stroke; cerebrovascular disease; Leukoaraiosis; meta-analysis; safety outcomes; thrombectomy; thrombolysis; white matter lesions |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 13 Sep 2022 05:39 |
| Last Modified: | 13 Sep 2022 05:39 |
| URI: | https://pred.uni-regensburg.de/id/eprint/47238 |
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