Severity of leukoaraiosis and susceptibility to infarct growth in acute stroke

被引:184
|
作者
Ay, Hakan [1 ,2 ,3 ,4 ]
Arsava, E. Murat [1 ]
Rosand, Jonathan [4 ,5 ,6 ,7 ]
Furie, Karen L. [4 ]
Singhal, Aneesh B. [4 ]
Schaefer, Pamela W. [1 ]
Wu, Ona [1 ]
Gonzalez, R. Gilberto [1 ]
Koroshetz, Walter J. [8 ]
Sorensen, A. Gregory [1 ]
机构
[1] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Radiol,AA Martinos Ctr Biomed Imaging, Charlestown, MA 02129 USA
[2] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Neurol,AA Martinos Ctr Biomed Imaging, Charlestown, MA 02129 USA
[3] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Radiol,Stroke Serv, Charlestown, MA 02129 USA
[4] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Neurol,Stroke Serv, Charlestown, MA 02129 USA
[5] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Ctr Human Genet Res, Boston, MA 02129 USA
[6] Broad Inst MIT, Program Med & Populat Genet, Cambridge, MA USA
[7] Harvard Univ, Cambridge, MA 02138 USA
[8] NINDS, NIH, Bethesda, MD 20892 USA
关键词
acute stroke; cerebral infarct; diffusion-weighted imaging; leukoaraiosis; MRI;
D O I
10.1161/STROKEAHA.107.501932
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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. Conclusion-LA volume at the time of acute ischemic stroke is a predictor infarct growth. Because LA is associated with factors that modulate tissue perfusion as well as tissue capacity for handling of ischemia, LA volume appears to be a composite predictive marker for the fate of acutely ischemic tissue.
引用
收藏
页码:1409 / 1413
页数:5
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