Abstract：
BACKGROUND: White matter hyperintensity (WMH) burden may lead to poor clinical outcomes after endovascular thrombectomy (EVT). But the relationship between WMH burden and cerebral edema (CED) is unclear.
OBJECTIVE: To examine the association between WMH burden and CED and functional outcome in patients treated with EVT.
METHODS: Retrospective.
METHODS: 344 patients with acute anterior circulation large-vessel occlusion stroke who received EVT at two comprehensive stroke centers. Mean age was 62.6 ± 11.6 years and 100 patients (29.1%) were female.
UNASSIGNED: 3T, including diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) images.
RESULTS: The severity of WMH was evaluated using the Fazekas scale on a FLAIR sequence before EVT. The severity of CED was assessed using CED score (three for malignant cerebral edema [MCE]) and net water uptake (NWU)/time on post-EVT cranial CT. The impact of WMH burden on MCE, NWU/time, and 3-month poor outcome (modified Rankin scale >2) after EVT were assessed.
METHODS: Pearson\'s chi-squared test, Fisher exact test, 2-tailed t test, Mann-Whitney U test, multivariable logistic regression, multivariate regression analysis, Sobel test. A P value <0.05 was considered statistically significant.
RESULTS: WMH burden was not significantly associated with MCE and parenchymal hemorrhage (PH) in the whole population (P = 0.072; P = 0.714). WMH burden was significantly associated with an increased risk of MCE (OR, 1.550; 95% CI, 1.128-2.129), higher NWU/time (Coefficient, 0.132; 95% CI, 0.012-0.240), and increased risk of 3-month poor outcome (OR, 1.434; 95% CI, 1.110-1.853) in the subset of patients without PH. Moreover, the connection between WMH burden and poor outcome was partly mediated by CED in patients without PH (regression coefficient changed by 29.8%).
CONCLUSIONS: WMH burden is associated with CED, especially MCE, and poor outcome in acute ischemic stroke patients treated with EVT. The association between WMH burden and poor outcome may partly be attributed to postoperative CED.
METHODS:
UNASSIGNED: Stage 5.
OBJECTIVE: To examine the association between WMH burden and CED and functional outcome in patients treated with EVT.
METHODS: Retrospective.
METHODS: 344 patients with acute anterior circulation large-vessel occlusion stroke who received EVT at two comprehensive stroke centers. Mean age was 62.6 ± 11.6 years and 100 patients (29.1%) were female.
UNASSIGNED: 3T, including diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) images.
RESULTS: The severity of WMH was evaluated using the Fazekas scale on a FLAIR sequence before EVT. The severity of CED was assessed using CED score (three for malignant cerebral edema [MCE]) and net water uptake (NWU)/time on post-EVT cranial CT. The impact of WMH burden on MCE, NWU/time, and 3-month poor outcome (modified Rankin scale >2) after EVT were assessed.
METHODS: Pearson\'s chi-squared test, Fisher exact test, 2-tailed t test, Mann-Whitney U test, multivariable logistic regression, multivariate regression analysis, Sobel test. A P value <0.05 was considered statistically significant.
RESULTS: WMH burden was not significantly associated with MCE and parenchymal hemorrhage (PH) in the whole population (P = 0.072; P = 0.714). WMH burden was significantly associated with an increased risk of MCE (OR, 1.550; 95% CI, 1.128-2.129), higher NWU/time (Coefficient, 0.132; 95% CI, 0.012-0.240), and increased risk of 3-month poor outcome (OR, 1.434; 95% CI, 1.110-1.853) in the subset of patients without PH. Moreover, the connection between WMH burden and poor outcome was partly mediated by CED in patients without PH (regression coefficient changed by 29.8%).
CONCLUSIONS: WMH burden is associated with CED, especially MCE, and poor outcome in acute ischemic stroke patients treated with EVT. The association between WMH burden and poor outcome may partly be attributed to postoperative CED.
METHODS:
UNASSIGNED: Stage 5.
摘要：
背景：血管内血栓切除术（EVT）后，白质高强度（WMH）负荷可能导致不良的临床预后。但是WMH负荷与脑水肿（CED）之间的关系尚不清楚。
目的：研究接受EVT治疗的患者WMH负荷与CED和功能结局之间的关系。
方法：回顾性。
方法：344例急性前循环大血管闭塞卒中患者在两个综合性卒中中心接受EVT治疗。平均年龄为62.6±11.6岁，女性患者100例（29.1%）。
■3T,包括弥散加权成像和流体衰减反演恢复(FLAIR)图像。
结果：在EVT之前使用Fazekas量表在FLAIR序列上评估WMH的严重程度。使用CED评分（恶性脑水肿[MCE]三项）和EVT后头颅CT的净摄水量（NWU）/时间评估CED的严重程度。WMH负担对MCE的影响，NWU/时间,评估EVT后3个月的不良结局（改良Rankin量表>2）。
方法：皮尔逊卡方检验，Fisher精确检验,双尾t检验，Mann-WhitneyU测试,多变量逻辑回归，多元回归分析，索贝尔测试。P值<0.05被认为是统计学上显著的。
结果：在整个人群中，WMH负荷与MCE和实质性出血（PH）没有显着相关（P=0.072；P=0.714）。WMH负担与MCE风险增加显著相关(OR，1.550；95%CI，1.128-2.129），较高的NWU/时间(系数，0.132；95%CI，0.012-0.240），并增加3个月不良结局的风险(OR，1.434；95%CI，1.110-1.853）在无PH患者亚组中。此外，在无PH患者中,WMH负荷与不良结局之间的联系部分由CED介导(回归系数变化29.8%).
结论：WMH负荷与CED相关，尤其是MCE,接受EVT治疗的急性缺血性卒中患者的预后较差。WMH负担与不良预后之间的关联可能部分归因于术后CED。
方法：
■阶段5.
目的：研究接受EVT治疗的患者WMH负荷与CED和功能结局之间的关系。
方法：回顾性。
方法：344例急性前循环大血管闭塞卒中患者在两个综合性卒中中心接受EVT治疗。平均年龄为62.6±11.6岁，女性患者100例（29.1%）。
■3T,包括弥散加权成像和流体衰减反演恢复(FLAIR)图像。
结果：在EVT之前使用Fazekas量表在FLAIR序列上评估WMH的严重程度。使用CED评分（恶性脑水肿[MCE]三项）和EVT后头颅CT的净摄水量（NWU）/时间评估CED的严重程度。WMH负担对MCE的影响，NWU/时间,评估EVT后3个月的不良结局（改良Rankin量表>2）。
方法：皮尔逊卡方检验，Fisher精确检验,双尾t检验，Mann-WhitneyU测试,多变量逻辑回归，多元回归分析，索贝尔测试。P值<0.05被认为是统计学上显著的。
结果：在整个人群中，WMH负荷与MCE和实质性出血（PH）没有显着相关（P=0.072；P=0.714）。WMH负担与MCE风险增加显著相关(OR，1.550；95%CI，1.128-2.129），较高的NWU/时间(系数，0.132；95%CI，0.012-0.240），并增加3个月不良结局的风险(OR，1.434；95%CI，1.110-1.853）在无PH患者亚组中。此外，在无PH患者中,WMH负荷与不良结局之间的联系部分由CED介导(回归系数变化29.8%).
结论：WMH负荷与CED相关，尤其是MCE,接受EVT治疗的急性缺血性卒中患者的预后较差。WMH负担与不良预后之间的关联可能部分归因于术后CED。
方法：
■阶段5.
