Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
UMass Memorial Medical Center University Campus, Worcester, Massachusetts, USA.
J Neurointerv Surg. 2021 Jan;13(1):19-24. doi: 10.1136/neurintsurg-2020-015940. Epub 2020 May 15.
White matter lesions (WML) are associated with poor outcome after mechanical thrombectomy (MT) for large vessel stroke; the reasons are uncertain. To elucidate this issue we sought to determine the association of WML with multiple early and late outcome measures after MT.
We retrospectively analyzed 181 MT patients prospectively included in our local stroke registry (January 2012 to November 2016). Using multiple regression modeling, we assessed whether WML was independently associated with early outcomes (successful recanalization, degree of National Institutes of Health Stroke Scale (NIHSS) improvement, hemorrhagic transformation, duration of hospitalization) as well as an unfavorable 90-day modified Rankin Scale score (mRS) (≥3) and 90-day survival. Explorative analyses examined the association with the 90-day home-time and 90-day risk for hospital readmission.
WML were not significantly associated with early outcome measure (P>0.05, each). Patients with moderate-to-severe WML more often had an unfavorable mRS (OR 2.93, 95% CI 1.04 to 8.33) and risk of death (HR 1.98, 95% CI 1.03 to 3.84) after adjustment for pertinent confounders. Patients with moderate-to-severe WML had a significantly shorter home-time (19±32 vs 47±38 days, P<0.001) and Kaplan-Meier analyses indicated a significantly greater risk for hospital readmission within 90 days (log rank P=0.045), with the most frequent reasons being recurrent stroke and transient ischemic attack.
Our analyses suggest that poor outcomes among patients with moderate-to-severe WML were related to factors unrelated to procedural success and risk. WML should not be used to render treatment decisions in otherwise eligible patients. Aggressive monitoring of medical complications after MT could represent a viable strategy to improve outcome in affected patients.
脑白质病变（WML）与大血管卒中机械取栓（MT）后的不良预后相关，但具体原因尚不清楚。为阐明这一问题，我们旨在明确 WML 与 MT 后多种早期和晚期结局指标的相关性。
我们回顾性分析了 2012 年 1 月至 2016 年 11 月期间纳入本地区卒中登记的 181 例 MT 患者。采用多元回归模型，我们评估了 WML 是否与早期结局（再通成功、美国国立卫生研究院卒中量表（NIHSS）评分改善程度、出血性转化、住院时间）以及 90 天改良 Rankin 量表评分（mRS）不良（≥3 分）和 90 天生存独立相关。探索性分析检查了与 90 天居家时间和 90 天再次住院风险的相关性。
WML 与早期结局指标之间无显著相关性（P>0.05，每项）。中重度 WML 患者更易发生 mRS 不良（OR 2.93，95%CI 1.04 至 8.33）和死亡风险（HR 1.98，95%CI 1.03 至 3.84），校正相关混杂因素后。中重度 WML 患者的居家时间显著缩短（19±32 天比 47±38 天，P<0.001），Kaplan-Meier 分析表明 90 天内再次住院的风险显著增加（对数秩 P=0.045），最常见的原因是复发性卒中和短暂性脑缺血发作。
我们的分析表明，中重度 WML 患者的预后不良与手术成功和风险无关的因素有关。在其他情况下，WML 不应作为治疗决策的依据。在 MT 后积极监测医疗并发症可能是改善受影响患者结局的可行策略。
