Christoph Johannes Griessenauer1,2, David McPherson3, Andrea Berger4, Ping Cuiper4, Nelson Sofoluke5, Matthew D Adams3, Saran Kunaprayoon3, Ramin Zand6, Jiang Li7, Vida Abedi7,8, Oded Goren5, Clemens M Schirmer5, Kathleen Donahue9, Marco Nardin9, Anne-Karin Giese9, Markus D Schirmer9, Natalia S Rost9, Philipp Hendrix5,10. 1. Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA, christoph.griessenauer@gmail.com. 2. Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria, christoph.griessenauer@gmail.com. 3. Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA. 4. Biostatistics Core, Geisinger, Danville, Pennsylvania, USA. 5. Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA. 6. Department of Neurology, Geisinger, Danville, Pennsylvania, USA. 7. Department of Molecular and Functional Genomics, Geisinger, Danville, Pennsylvania, USA. 8. Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia, USA. 9. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 10. Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.
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.
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 strokepatients 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: Abdul Ghani Mikati; Max Mandelbaum; Shweta Sapnar; Ajit S Puri; Brian Silver; Richard P Goddeau; Diogo C Haussen; Majaz Moonis; Adalia H Jun-O'Connell; Nils Henninger Journal: Transl Stroke Res Date: 2019-04-12 Impact factor: 6.829
Authors: Maarten G Lansberg; Michael Mlynash; Scott Hamilton; Sharon D Yeatts; Soren Christensen; Stephanie Kemp; Philip W Lavori; Santiago Ortega-Gutierrez; Joe Broderick; Jeremy Heit; Michael P Marks; Gregory W Albers Journal: JAMA Neurol Date: 2019-04-01 Impact factor: 18.302
Authors: William J Powers; Alejandro A Rabinstein; Teri Ackerson; Opeolu M Adeoye; Nicholas C Bambakidis; Kyra Becker; José Biller; Michael Brown; Bart M Demaerschalk; Brian Hoh; Edward C Jauch; Chelsea S Kidwell; Thabele M Leslie-Mazwi; Bruce Ovbiagele; Phillip A Scott; Kevin N Sheth; Andrew M Southerland; Deborah V Summers; David L Tirschwell Journal: Stroke Date: 2019-10-30 Impact factor: 7.914
Authors: Markus D Schirmer; Adrian V Dalca; Ramesh Sridharan; Anne-Katrin Giese; Kathleen L Donahue; Marco J Nardin; Steven J T Mocking; Elissa C McIntosh; Petrea Frid; Johan Wasselius; John W Cole; Lukas Holmegaard; Christina Jern; Jordi Jimenez-Conde; Robin Lemmens; Arne G Lindgren; James F Meschia; Jaume Roquer; Tatjana Rundek; Ralph L Sacco; Reinhold Schmidt; Pankaj Sharma; Agnieszka Slowik; Vincent Thijs; Daniel Woo; Achala Vagal; Huichun Xu; Steven J Kittner; Patrick F McArdle; Braxton D Mitchell; Jonathan Rosand; Bradford B Worrall; Ona Wu; Polina Golland; Natalia S Rost Journal: Neuroimage Clin Date: 2019-05-29 Impact factor: 4.881
Authors: Adnan Khan; Ajay Menon; Naveed Akhtar; Saadat Kamran; Ahmad Muhammad; Georgios Ponirakis; Hoda Gad; Ioannis N Petropoulos; Faisal Wadiwala; Blessy Babu; Adeeb M Narangoli; Pablo G Bermejo; Hanadi Al Hamad; Marwan Ramadan; Peter Woodruff; Mark Santos; Maher Saqqur; Ashfaq Shuaib; Rayaz A Malik Journal: Sci Rep Date: 2021-10-05 Impact factor: 4.379