Influence de la leucopathie vasculaire sur l’issue clinique des patients traités par thrombectomie mécanique à la phase aiguë de l’AVC ischémiques : résultats dans l’essai THRACE associé à une cohorte multicentrique - 29/03/19
, Nicolas Bricout, MD, MSc 1, Wagih Benhassen, MD, MSc 1, Marc Ferrigno, MD 2, Guillaume Turc, MD, PhD 3, Martin Bretzner, MD 1, Joseph Benzakoun, MD, MSc 1, Pierre Seners, MD, PhD 3, Thomas Personnic, MD, MSc 2, Laurence Legrand, MD, MSc 1, Denis Trystram, MD, MSc 1, Christine Rodriguez-Regent, MD, MSc 1, Andreas Charidimou, MD, PhD 4, Natalia S. Rost, MD, MPH 4, Serge Bracard, MD 5, Charlotte Cordonnier, MD, PhD 2, Catherine Oppenheim, MD, PhD 1, Olivier Naggara, MD, PhD 1, a, Hilde Henon, MD, PhD 2, aRésumé |
Introduction |
Cerebral white matter hyperintensity (WMH) on FLuid Attenuated Inversion Recovery (FLAIR) is linked to less favourable outcome in patients with acute ischemic stroke (AIS) but data on their relevance in patients with large vessel occlusion (LVO) treated with mechanical thrombectomy (MT) are sparse. In this post-hoc analysis of the MT arm of the THRACE trial and multicenter retrospective cohorts, we aimed to determine the influence of WMH burden on clinical outcome, rate of symptomatic intracranial hemorrhage (ICH) and procedural success in AIS patients treated by MT with current stentriever/aspiration devices.
Patients and methods |
Patients from the MT arm of THRACE trial, and prospective cohorts from two academic comprehensive stroke centers were pooled and retrospectively analyzed. WMH volumes were obtained by semi-automated planimetric segmentation and tested in association with the rate of favourable outcome (mRS 0-2 at at 90 days), successful recanalization after MT (mTICI≥2B), and symptomatic ICH.
Results |
A total of 535 subjects met inclusion criteria between 2015 and 2018 (49 % female, mean age 68,0 years±15,0 Overall, 458 (85,6 %) patients presented with detectable WMH (median volume 5,7cc IQR [2,8–12,7]). Patients demonstrated increasingly worse outcomes with increasing WMH volumes), with 57 % of patients in the 1st quartile of WMH volume demonstrating favourable outcome vs. 27 % in the 4th (p<0,001), aOR :1.3 95 %CI [1,04–1,70], P=0,021 when WMH analyzed as a linear variable. WMH severity was not associated with sICH rate (aOR : 1,08 [0,53–1,64], p=0,796) nor did it influence recanalization success (aOR :1.04 [0,84–1,29], p=0,67).
Conclusion |
Our study provides evidence that patients with AIS due to LVO and severe WMH as assessed by pre-treatment MRI, are at higher risk for less favourable outcome following MT, despite similar rates of sICH and procedural success. Since 27 % of patients with severe WMH in our sample experienced favourable outcome at 3 months, severe WMH burden may not preclude MT.
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Vol 46 - N° 2
P. 74 - mars 2019 Retour au numéro
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