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Research ArticleInterventional
Open Access

White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke

E.A. Mistry, A.M. Mistry, T. Mehta, N. Arora, A.K. Starosciak, F.D.L.R. La Rosa, J.E. Siegler, S.E. Kasner, R. Chitale, M. Fusco, M. Froehler, S. Yaghi, M. Schrag and P. Khatri on behalf of BEST Collaborators
American Journal of Neuroradiology April 2020, 41 (4) 639-644; DOI: https://doi.org/10.3174/ajnr.A6478
E.A. Mistry
aFrom the Departments of Neurology (E.A.M., M.S.) and
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A.M. Mistry
bNeurosurgery (A.M.M., R.C., M. Fusco), and
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T. Mehta
dDepartment of Neurology and Neurosurgery (T.M.), University of Minnesota, Minneapolis, Minnesota
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N. Arora
eDepartment of Neurology (N.A.), University of Missouri, Columbia, Missouri
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A.K. Starosciak
fBaptist Health Neuroscience Center (A.K.S., F.D.L.R.L.R.), Miami, Florida
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F.D.L.R. La Rosa
fBaptist Health Neuroscience Center (A.K.S., F.D.L.R.L.R.), Miami, Florida
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J.E. Siegler
gDepartment of Neurology (J.E.S., S.E.K.), University of Pennsylvania, Philadelphia, Pennsylvania
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S.E. Kasner
gDepartment of Neurology (J.E.S., S.E.K.), University of Pennsylvania, Philadelphia, Pennsylvania
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R. Chitale
bNeurosurgery (A.M.M., R.C., M. Fusco), and
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M. Fusco
bNeurosurgery (A.M.M., R.C., M. Fusco), and
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M. Froehler
cCerebrovascular Program (M. Froehler), Vanderbilt University Medical Center, Nashville, Tennessee
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S. Yaghi
hNew York University Langone Health (S.Y.), Brooklyn, New York
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M. Schrag
aFrom the Departments of Neurology (E.A.M., M.S.) and
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P. Khatri
iDepartment of Neurology and Rehabilitation Medicine (P.K.), University of Cincinnati, Cincinnati, Ohio.
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    Figure.

    Distribution of the 90-day mRS score according to white matter disease severity graded with the van Swieten scale score.

Tables

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    Table 1:

    Baseline characteristics of patients with no-to-minimal (van Sweeten score, 0–2) and moderate-to-severe (van Swieten score, 3–4) white matter disease

    van Swieten 0–2 (n = 315)van Swieten 3–4 (n = 74)P Value
    Age (mean) (±SD) (yr)66 (±15)76 (±12)<.001
    Male (%)164 (52)32 (43).2
    Hypertension (%)224 (71)68 (92)<.001
    Diabetes (%)92 (29)23 (31).78
    Glucose (median) (IQR)122 (102–146)131 (115–162).009
    NIHSS (median) (IQR)15 (10–20)17 (11–21).16
    ASPECTS (median) (IQR)8 (7–10)8 (7–9).07
    Core volume (mean) (±SD)20 (±24)19 (±26).85
    Penumbra volume (mean) (±SD)119 (±71)124 (±71).69
    Systolic BP on admission (mean) (± SD)154 (±29)168 (±29)<.001
    Time from last known well to reperfusion (median) (IQR)274 (180–534)286 (190–676).2
    Intravenous thrombolysis (%)160 (51)29 (39).09
    Prior stroke (%)52 (16)19 (26).09
    • Note:—BP indicates blood pressure; IQR, interquartile range.

    • View popup
    Table 2:

    Outcomes of patients with no-to-minimal (van Swieten score, 0–2) and moderate-to-severe (van Swieten score, 3–4) white matter disease

    Outcomevan Swieten 0–2 (n = 315)van Swieten 3–4 (n = 74)Unadjusted OR with 95% CIP ValueAdjusted OR with 95% CIP Value
    90-Day mRS 0–2 (%)141/295 (45)13/70 (18)0.25 (0.13–0.46)<.0010.37 (0.17–0.75).008
    90-Day mRS 0–3 (%)184/295 (58)29/70 (39)0.43 (0.25–0.73).0020.75 (0.40–1.43).38
    Shift in the 90-day mRSNANA2.86 (1.83–4.52)<.0013.05 (1.93–4.84)<.001
    Death (%)47 (15)19 (26)1.97 (1.06–3.57).0291.14 (0.56–2.26).71
    Symptomatic ICH (%)13 (4)4 (5)1.33 (0.37–3.88).629NANA
    mTICI ≥ 2b (%)275 (87)68 (92)1.65 (0.72–4.47).27NANA
    ENI (%)132 (42)30 (40)0.95 (0.56–1.58).83NANA
    • Note:—mTICI indicates modified TICI; ENI, early neurologic improvement; NA, not applicable.

    • View popup
    Table 3:

    Outcomes of patients with successful recanalization (mTICI ≥ 2b) according to the severity of baseline white matter disease

    Outcomevan Swieten 0–2 (n = 275)van Swieten 3–4 (n = 68)P Value
    90-Day mRS 0–2 (%)132/258 (52)13/65 (20)<.001
    90-Day mRS 0–3 (%)169/258 (65.5)28/65 (43).002
    Death (%)34 (12.4)17 (25.0).013
    Symptomatic ICH (%)10 (3.6)3 (4.4).73
    ENI (%)124 (45.1)30 (44.1)1.0
    • Note:—ENI indicates early neurologic improvement.

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American Journal of Neuroradiology: 41 (4)
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E.A. Mistry, A.M. Mistry, T. Mehta, N. Arora, A.K. Starosciak, F.D.L.R. La Rosa, J.E. Siegler, S.E. Kasner, R. Chitale, M. Fusco, M. Froehler, S. Yaghi, M. Schrag, P. Khatri
White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke
American Journal of Neuroradiology Apr 2020, 41 (4) 639-644; DOI: 10.3174/ajnr.A6478

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White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke
E.A. Mistry, A.M. Mistry, T. Mehta, N. Arora, A.K. Starosciak, F.D.L.R. La Rosa, J.E. Siegler, S.E. Kasner, R. Chitale, M. Fusco, M. Froehler, S. Yaghi, M. Schrag, P. Khatri
American Journal of Neuroradiology Apr 2020, 41 (4) 639-644; DOI: 10.3174/ajnr.A6478
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