The Relationship Between Leukoaraiosis And Symptomatic Intracranial Hemorrhage After Thrombectomy In Acute Large Vessel Occlusive Stroke

Objective:To investigate the risk factors of leukoaraiosis(LA)degree and to analyze the relationship between leukoaraiosis degree and symptomatic intracranial hemorrhage(SICH)of patients with acute anterior circulation large vessel occlusive(LVO)stroke after mechanical thrombectomy(MT).Methods:Clinical data of 106 patients with acute anterior circulation large vessel occlusive stroke who received mechanical thrombectomy in the Department of Neurology of the Fourth Affiliated Hospital of China Medical University from January 2018 to June 2020 were collected.The degree of LA severity was evaluated on head Magnetic Resonance Imaging(MRI)-T2-weighted images and Fazekas scale before thrombectomy.The patients were divided into non-to-moderate LA group(78 cases)and moderate-to-severe LA group(28 cases).The general information of the two groups was compared.In this study,symptomatic intracranial hemorrhage was defined as hemorrhage indicated by reexamination of head Computed Tomography(CT)immediately after surgery,24～72 hours after surgery or acute deterioration of neurological function,resulting in deterioration of neurological function,and National Institutes of Health Stroke Scale(NIHSS)score increased ≥4 points compared with before treatment.The patients were divided into SICH group(19 cases)and non Symptomatic Intracranial Hemorrhage(n SICH)group(87 cases).Univariate analysis was used to compare the baseline data,imaging and laboratory tests between the two groups.The independent correlation between LA and SICH was analyzed by multivariate logistic regression.Results: Among 106 patients,78 were into the non-to-moderate LA group,and 28 were into the moderate-to-severe LA group.As compared with patients in the non-to-moderate LA group,patients in the moderate-to-severe LA group had significantly older age(69.86±9.83 years vs 62.72±11.40 years;P=0.004),significantly higher baseline NIHSS scores(16.21±6.23 vs 12.15±6.00;P=0.003),significantly higher proportion of poor collateral circulation(92.86% vs 66.67%;P=0.007),significantly higher incidence of postoperative SICH(39.29% vs 10.26%;P=0.001),significantly lower rate of good prognosis 90 days after surgery(17.86% vs57.69%;P=0.000).Among 106 patients,19 were in the SICH group and 87 were in the n SICH group.Univariate analysis showed that as compared with those from the n SICH group,patients from the SICH group had significantly higher baseline NIHSS scores(16.95±5.65 points vs 12.41±6.17 points;P=0.004),significantly higher number of thrombectomy(2.53±1.43 vs 1.74±1.06;P=0.007),significantly higher proportion of moderate-to-severe LA(57.89% vs 19.54%;P=0.001),significantly higher incidence of cardiogenic stroke(47.37% vs 24.14%;P=0.042),significantly higher proportion of poor collateral circulation(94.74% vs 68.97%;P=0.021)and significantly lower rate of good prognosis at 90 days(0.00% vs 57.47%;P=0.000);Multivariate Logistic regression analysis showed that moderate-to-severe LA(OR 4.544,95%CI 1.355-15.236,P=0.014)and the number of thrombolectomy(OR 1.629,95%CI 1.047-2.534,P=0.030)were independent risk factors for SICH after mechanical thrombolectomy.Conclusion: 1.Age and poor collateral circulation are risk factors for moderate-to-severe LA;Moderate-to-severe LA was associated with baseline NIHSS scores,and the baseline NIHSS scores of moderate-to-severe LA were higher than those of non-to-moderate LA.2.The rate of good prognosis 90 days after surgery is lower in moderate-to-severe LA patients.3.Moderate-to-severe LA,the number of thrombectomy,baseline NIHSS scores,cardiogenic stroke,and poor collateral circulation are risk factors for SICH after thrombectomy,among which,moderate-to-severe LA and the number of thrombectomy are independent risk factors for SICH.