Ghozy Sherief, Ahmadzade Ali, Jazayeri Seyed Behnam, Elfil Mohamed, Hasanzadeh Alireza, Tehrani Niyousha Rafiee, Gorjestani Omid R, Kobeissei Hassan, Abbas Alzhraa S, Dmytriw Adam A, Kadirvel Ramanathan, Malhotra Ajay, Kallmes David F
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Eur Radiol. 2025 May 13. doi: 10.1007/s00330-025-11658-2.
Endovascular thrombectomy (EVT) is the standard of care for eligible patients with large vessel occlusion (LVO). Yet, little is known regarding the impact of leukoaraiosis (LA) on outcomes following EVT for LVO.
We conducted a systematic review and meta-analysis to investigate the impact of LA on outcomes following EVT.
A literature search was performed in PubMed, Embase, Scopus, and Web of Science, from inception until January 7, 2024. Patients were categorized into two groups based on the level of LA: one with absent to mild LA (AMLA) and the other with moderate to severe LA (MSLA). The primary outcome of interest was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), thrombolysis in cerebral infarction (TICI) score 2b-3, and mortality. Using R software, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI).
We included 18 studies with 7022 patients. MSLA was associated with lower rates of mRS 0-2 (OR, 0.32 [95% CI: 0.26-0.41]; p < 0.001), similar rates of TICI 2b-3 (OR, 0.91 [95% CI: 0.77-1.07]; p = 0.235) and sICH (OR, 1.18 [95% CI: 0.92-1.51]; p = 0.202), and greater rates of mortality (OR, 2.89 [95% CI: 2.38-3.52]; p < 0.001) compared to AMLA.
MSLA is associated with lower rates of mRS 0-2 and worse safety outcomes following EVT for LVO, despite similar rates of TICI 2b-3. Future prospective studies should further study MSLA as a prognosticator following EVT.
Question Does the severity of LA impact functional and safety outcomes following EVT for acute ischemic stroke due to LVO? Findings Moderate-to-severe LA was associated with lower rates of good functional outcome and higher mortality following EVT, despite similar rates of successful reperfusion and sICH. Clinical relevance LA severity is an independent prognostic factor in EVT outcomes. Identifying patients with moderate-to-severe LA can aid in risk stratification and post-procedural management, optimizing individualized stroke treatment and follow-up strategies.
血管内血栓切除术（EVT）是符合条件的大血管闭塞（LVO）患者的标准治疗方法。然而，关于脑白质疏松症（LA）对LVO患者EVT术后结局的影响知之甚少。
我们进行了一项系统评价和荟萃分析，以研究LA对EVT术后结局的影响。
在PubMed、Embase、Scopus和Web of Science数据库中进行文献检索，检索时间从数据库建立至2024年1月7日。根据LA的程度将患者分为两组：一组为无至轻度LA（AMLA），另一组为中度至重度LA（MSLA）。主要关注结局为90天改良Rankin量表（mRS）评分为0 - 2分。次要结局包括症状性颅内出血（sICH）、脑梗死溶栓（TICI）评分2b - 3分以及死亡率。使用R软件计算合并比值比（OR）及其相应的95%置信区间（CI）。
我们纳入了18项研究，共7022例患者。与AMLA相比，MSLA组mRS 0 - 2分的比例较低（OR，0.32 [95% CI：0.26 - 0.41]；p < 0.001），TICI 2b - 3分的比例相似（OR，0.91 [95% CI：0.77 - 1.07]；p = 0.235），sICH的比例相似（OR，1.18 [95% CI：0.92 - 1.51]；p = 0.202），而死亡率更高（OR，2.89 [95% CI：2.38 - 3.52]；p < 0.001）。
对于LVO患者的EVT，MSLA与mRS 0 - 2分的比例较低以及安全性结局较差相关，尽管TICI 2b - 3分的比例相似。未来的前瞻性研究应进一步研究MSLA作为EVT术后的预后指标。
问题LA的严重程度是否会影响因LVO导致的急性缺血性卒中患者EVT后的功能和安全性结局？发现尽管成功再灌注率和sICH率相似，但中度至重度LA与EVT后良好功能结局的比例较低和死亡率较高相关。临床意义LA严重程度是EVT结局的独立预后因素。识别中度至重度LA患者有助于进行风险分层和术后管理，优化个体化的卒中治疗和随访策略。
