Severity of Leukoaraiosis and Susceptibility to Infarct Growth in Acute Stroke

作者：Hakan Ay, Ethem Murat Arsava, Jonathan M. Rosand, Karen L. Furie, Aneesh B. Singhal, Pamela Whitney Schaefer, Ona Wu, R. Gilberto González, Walter J. Koroshetz, Alma Gregory Sorensen · 发表于：Stroke · 年份：2008 · DOI：10.1161/strokeaha.107.501932 · 被引用次数：176 · 研究领域：Acute Ischemic Stroke Management、Cerebrovascular and Carotid Artery Diseases、Dementia and Cognitive Impairment Research

BACKGROUND AND PURPOSE: Leukoaraiosis (LA) is associated with structural and functional vascular changes that may compromise tissue perfusion at the microvascular level. We hypothesized that the volume of LA correlated with the proportion of initially ischemic but eventually infarcted tissue in acute human stroke. METHODS: We studied 61 consecutive patients with diffusion-weighted imaging-mean transit time mismatch. All patients were scanned twice within 12 hours of symptom onset and between days 4 and 30. We explored the relationship between the volume of white matter regions with LA on acute images and the proportion of diffusion-weighted imaging-mean transit time mismatch tissue that progressed to infarction (percentage mismatch lost). RESULTS: Bivariate analyses showed a statistically significant correlation between percentage mismatch lost and LA volume (r=0.33, P<0.01). A linear regression model with percentage mismatch lost as response and LA volume, acute diffusion-weighted imaging and mean transit time volumes, age, admission blood glucose level, admission mean arterial blood pressure, etiologic stroke subtype, time to acute MRI, and time between acute and follow-up imaging as covariates revealed that LA volume was an independent predictor of infarct growth (P=0.04). The adjusted percentage mismatch lost in the highest quartile of LA volume was 1.9-fold (95% CI: 1.2 to 3.1) greater than the percentage mismatch lost in the lowest quartile. CONCLUSIONS: LA volume at th...