Severe Leukoaraiosis Research Articles

Leukoaraiosis and acute ischemic stroke: 90-day clinical outcome following endovascular recanalization, with proposed “L-ASPECTS”

BackgroundTo assess if leukoaraiosis severity is associated with outcome in patients with acute ischemic stroke (AIS) following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score.MethodsA retrospective...

Association of FLAIR vascular hyperintensity and acute MCA stroke outcome changes with the severity of leukoaraiosis.

The clinical significance of FLAIR vascular hyperintensity (FVH), a marker of collateral circulation in ischaemic stroke, remains controversial. We hypothesised that the association between FVH and outcomes varies with the severity of leukoaraiosis (LA), another marker of collaterals, and that their combined significance may vary with time. We included 459 consecutive patients with middle cerebral artery (MCA) stroke. Proximal and distal FVHs were distinguished based on location. LA was divided into two grades, according to Fazekas scores of 0-2 and 3-6. Symptom-to-MRI time was divided into two categories: ≤ 14days and ≥ 15days. We found no difference in FVH proportion according to LA grade. Multivariate analysis revealed that LA and FVH status were independently associated with unfavourable outcomes (modified Rankin scale ≥ 2) in patients with symptom-to-MRI times ≤ 14days (P = 0.008), but not in those with symptom-to-MRI times ≥15days (P = 0.61). In the group with symptom-to-MRI times ≤14days, patients with LA 3-6 and FVH(+) (OR, 3.044; 95% CI, 1.116-8.305) were more likely to have unfavourable clinical outcomes compared with patients with LA 0-2 and FVH(+) but not compared with those with LA 0-2 and FVH(-) or LA 3-6 and FVH(-). In addition, FVH location did not influence the relationship between FVH and outcomes. The association between FVH and outcomes was influenced by the degree of LA in the acute but not in the subacute and chronic stages of MCA infarction. FVH predicts clinical outcomes independently only in those with more extensive LA.

The relationship of leukoaraiosis, haemorrhagic transformation and prognosis at 3\xa0months after intravenous thrombolysis in elderly patients aged \u2265\u200960\xa0years with acute cerebral infarction

BackgroudAs the elderly stroke population continues to increase, we will have to confront greater challenges regarding how to choose suitable patients to reduce thrombolysis-related bleeding events and accurately judge their prognosis. Therefore, we evaluated the relationship among leukoaraiosis (LA), haemorrhagic transformation (HT) and the prognosis at 3 months after intravenous (IV) thrombolysis in elderly patients aged ≥ 60 years with acute cerebral infarction (ACI).MethodsWe prospectively and consecutively chose 125 elderly patients aged ≥ 60 years with ACI who could accept and be suitable for IV recombinant tissue plasminogen activator (rtPA) after excluding 6 cases. Brain computed tomography(CT) was used to assess LA by using the modified Van Swieten scale (mVSS) before treatment and the modified Rankin scale (mRS) to appraise prognosis at 3 months after IV rtPA. Binary logistic regression was used to analyse the predictors of HT and the prognosis of ACI.ResultsOur data indicated that by brain CT, 26.4% of all patients showed severe LA, and the rate of HT and symptomatic intracranial haemorrhage (sICH) were 12.0% and 9.6%, respectively. Severe LA was evidently associated with HT (odds ratio [OR] 3.272, 95% confidence interval [CI] 1.010–10.598, P = 0.048) rather sICH (P > 0.05). Moreover, we also found that severe LA was associated with poor functional prognosis (OR 5.266, 95% CI 1.592–17.419, P = 0.006).ConclusionOur results showed that LA was associated with HT and adverse clinical prognosis rather sICH after IV rtPA in elderly patients aged ≥60 years with ACI. Although LA may increase the risk of bleeding but not fatal haemorrhage after IV thrombolysis, therefore, we should actively select an appropriate elderly population for thrombolytic treatment and have reasonable judgments on the outcomes.

Longer Duration of Hypertension and MRI Microvascular Brain Alterations Are Associated with Lower Hippocampal Volumes in Older Individuals with Hypertension.

Background:Hippocampal atrophy is associated with cognitive decline. Determining the clinical features associated with hippocampal volume (HV)/atrophy may help in tailoring preventive strategies.Objective:This study was aimed to investigate the association between HV (at visit 2) and vascular status (both at visit 1 and visit 2) in a cohort of individuals aged 60+ with hypertension and without overt cognitive impairment at visit 1 (visit 1 and visit 2 were separated by approximately 8 years).Methods:Hippocampal volume was estimated in brain MRIs as HV both clinically with the Scheltens’ Medial Temporal Atrophy score, and automatically with the Free Surfer Software application. A detailed medical history, somatometric measurements, cognitive tests, leukoaraiosis severity (Fazekas score), vascular parameters including pulse wave velocity, central blood pressure, and carotid artery plaques, as well as several biochemical parameters were also measured.Results:113 hypertensive patients, 47% male, aged 75.1±5.6 years, participated in both visit 1 and visit 2 of the ADELAHYDE study. Age (β= –0.30) and hypertension duration (β= –0.20) at visit 1 were independently associated with smaller HV at visit 2 (p < 0.05 for all). In addition to these variables, low body mass index (β= 0.18), high MRI Fazekas score (β= –0.20), and low Gröber-Buschke total recall (β= 0.27) were associated with smaller HV at visit 2 (p < 0.05 for all).Conclusion:In a cohort of older individuals without cognitive impairment at baseline, we described several factors associated with lower HV, of which hypertension duration can potentially be modified.

Leukoaraiosis and earlier neurological outcome after mechanical thrombectomy in acute ischemic stroke

Background and purposeThe aim of the study was to evaluate whether leukoaraiosis (LA) severity is associated with earlier neurological outcome in acute stroke patients undergoing mechanical thrombectomy. Materials and methodsIn this retrospective multicenter study, we evaluated 273 acute stroke patients treated with mechanical thrombectomy. LA severity was graded as 0–2 (absent-to-moderate) versus 3–4 (severe) according to the van Swieten scale. The main clinical outcome was the proportion of early neurological improvement and early neurological deterioration. Early neurological improvement was defined as a decrease of≥4 points on the NIHSS, or an NIHSS score of zero 24hours after baseline assessment. Early neurological deterioration was defined as an increase of≥4 points on the NIHSS 24hours after baseline assessment. ResultsThere was a significantly lower early neurological improvement rate (17.1% versus 39.2%; P=0.006) and non-significantly higher early neurological deterioration rate (29.3% versus 17.7%; P=0.084) in patients with severe LA (sLA) compared with patients with absent-to-moderate LA. In multivariable analysis, sLA was inversely associated with early neurological improvement (OR, 0.31; 95% CI, 0.13–0.78; P=0.012). There was no significant association of sLA with early neurological deterioration. However, in patients without symptomatic intracranial hemorrhage, sLA was an independent predictor of early neurological deterioration (OR, 2.65; 95% CI, 1.09–6.45; P=0.032). ConclusionssLA is a significant negative predictor of early neurological improvement and is an independent predictor of early neurological deterioration in patients without symptomatic intracranial hemorrhage.

Abstract WMP20: Effect of Leukoaraiosis on Outcomes of Mechanical Thrombectomy and Proposed New Leukoaraiosis-Aspects Score

Background and Purpose: Leukoaraiosis is a poor prognostic marker for patients with acute ischemic stroke (AIS). This study sought to assess if severity of leukoaraiosis is associated with outcome in patients with AIS following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score to improve its predictive value for good outcome. Methods: We analyzed consecutive patients with AIS that underwent mechanical thrombectomy for anterior circulation large vessel occlusion at our comprehensive stroke center. Leukoaraiosis burden was graded using the Fazekas scale (combined scores from two locations categorically divided into no leukoaraiosis (score = 0), mild (1-2), moderate (3-4) and severe (5-6)). The primary outcome measure was 90-day mRS. A proposed Leukoaraiosis-ASPECTS (“L-ASPECTS”) was calculated by subtracting values from the traditional ASPECT based on leukoaraiosis severity (1 point subtracted if mild, 2 if moderate, 3 if severe). Results: Of 174 included patients, 89 (51.2%) were female; average age was 68.0±9.1. 28 (16.1%) had no leukoaraiosis, 66 (37.9%) had mild, 62 (35.6%) had moderate, and 18 (10.3%) had severe. Leukoaraiosis severity was associated with worse 90-day mRS among all patients (p=0.0005) as well as those that were successfully revascularized (p=0.0002). A multivariate analysis confirmed that leukoaraiosis burden was associated with worse 90-day mRS among all patients (mild: p=0.006; moderate: p=0.002; severe: p=0.03), as well as those that underwent successful thrombectomies (p=0.005). Both L-ASPECTS and ASPECTS were associated with poor outcomes, but the association was stronger with L-ASPECTS (p&lt;0.0001 and AUC=0.7 for L-ASPECTS; p=0.04 and AUC=0.59 for ASPECTS). Conclusion: Leukoaraiosis severity on pre-mechanical thrombectomy NCCT is associated with worse 90-day outcome in patients with AIS following endovascular recanalization, and is an independent risk factor for worse outcomes. A proposed L-ASPECTS score had stronger association with outcome than the traditional ASPECTS score.

Abstract TP67: The Contribution of White Matter Pathology to Language Deficits Following Acute Subcortical Left Hemisphere Stroke

Background: White matter degeneration, or leukoaraiosis (LA), occurs in aging and increases risk of subcortical stroke. Yet, it remains unclear whether frank lesion and LA are independently predictive of language impairments in patients with left hemisphere (LH) acute subcortical stroke. Methods: Patients with acute LH subcortical stroke (&lt;10 days post-onset) participated (n=75). We manually traced lesions on DWI scans and calculated lesion volume/location with NiiStat. LH and right hemisphere (RH) LA were rated on T2-weighted images using the Fazekas et al. (1987) periventricular (PVH) and deep white matter hyperintensities (DWMH) subscales. We generated language z-scores reflecting auditory comprehension, naming, and repetition skills. We assessed relationships between demographic and stroke factors and LA using t-tests and correlations. We used hierarchical linear regression to determine independent associations between lesion volume and LA and language deficits. Results: For each hemisphere and Fazekas subscale, we found no significant associations between LA severity and lesion volume (r=-.27- -.07, p&gt;.08) or sex (t=.78-1.51, p&gt;.14). Older age was significantly related to more severe LA (r=.40-.49, p&lt;.001). Greater lesion volume was associated with poorer language abilities (t=-2.08, p=.04). When LH and RH PVH ratings were separately added to this model, both multivariate models were significant (F=3.90 p=.03 (LH), F=3.66, p=.03 (RH)), yet neither lesion volume (p=.08 (LH), p=.08 (RH)) nor PVH ratings (p=.06 (LH), p=.10 (RH)) independently predicted language. Models containing lesion volume and DWMH ratings were not significant (p&gt;.11). Discussion: Overall, lesion volume but not LA independently predicts language abilities in patients with acute subcortical LH stroke. Future directions include investigating the individual contributions of frank lesion, LA, and hypoperfusion on aphasia in a larger cohort of patients with acute subcortical stroke.

Abnormal blood pressure circadian rhythms are relevant to cerebral infarction and Leukoaraiosis in hypertensive patients

BackgroundTo investigate the relationships between blood pressure (BP) circadian rhythms and acute cerebral infarction (ACI), silent cerebral infarction (SCI) and the severity of leukoaraiosis in hypertensive patients.MethodsA retrospective case-control study was performed among hypertensive patients with 24-h ambulatory blood pressure monitoring (ABPM) and cranial magnetic resonance imaging (MRI).ResultsA total of 1267 patients were enrolled. Lower nocturnal blood pressure (BP) decreases were observed in ACI patients than in controls (3.3% vs 8.2%, P<0.001). Reverse-dipper pattern (RD) and non-dipper pattern (ND) were found to be independent risk factors for ACI. In ACI patients, both RD and ND BP circadian rhythms were revealed to be independent risk factors for moderate-severe leukoaraiosis. In addition, in SCI patients, RD (OR = 1.7, 95% CI, 0.9–3.0; P = 0.047) or extreme-dipper pattern (ED) (OR = 2.9, 95% CI, 1.2–7.0; P = 0.015) were found to be independent risk factors for moderate-severe leukoaraiosis. Moreover, the greater the severity of leukoaraiosis was, the higher the ratio of abnormal BP circadian rhythms.ConclusionRD and ND BP circadian rhythms might not only be relevant to the onset of ACI but also correlate with the severity of leukoaraiosis. Thus, when modulating BP with antihypertensive drugs, the BP circadian rhythms, and not merely the BP level, should warrant more attention.

Leukoaraiosis and collateral blood flow in stroke patients with anterior circulation large vessel occlusion

BackgroundLeukoaraiosis and collateral blood flow are processes that involve small vessels, the former related to flow within the deep perforating arterioles and the latter involving the small, cortical pial-pial connections,...

The Role of Leukoaraiosis on Outcomes and Recombinant Tissue-Plasminogen Activator-Related Symptomatic Intracerebral Hemorrhages in Acute Stroke

Background and Purpose: We aimed to assess whether severe leukoaraiosis (LA) is associated with outcomes and symptomatic intracerebral hemorrhages (sICH) in patients who were treated with recombinant tissue-plasminogen activator (rt-PA) for acute stroke. Methods: We analyzed the data of anterior circulation stroke patients who were treated with rt-PA at our stroke center during 2009–2016. LA was scored according to the van Swieten scale (VSS) on computed tomography (CT) and dichotomized into groups as absent or moderate versus severe LA. We used the safe implementation of thrombolysis in stroke definition for sICH and the modified Rankin Scale (mRS) scores at 3 months after rt-PA were recorded. Results: Of 302 patients, 47 (15.6%) showed severe LA (VSS &gt;4) on CT. The overall sICH rate was 3.6%. Moreover, sICH was significantly more frequent in patients with severe LA (n = 5 of 47; 10.6%) than in patients with absent/moderate LA (n = 6 of 255; 2.4%; P = 0.017). In addition, patients with severe LA had higher baseline glucose level (P = 0.006) and systolic blood pressure (P = 0.005) compared to patients with absent/moderate LA. Patients with severe LA were more likely to have a poor outcome (mRS: 3–6) compared to those without severe LA (P = 0.009). Conclusion: The presence of severe LA on CT increases the risk of sICH and poor outcome in patients treated with rt-PA for acute stroke.

Distribution preponderance of cerebral microbleeds according to severity of leukoaraiosis in Alzheimer's disease

Cerebral microbleeds (CMBs) and leukoaraiosis (LA) are common findings in Alzheimer's disease (AD). But clinical or topographic relation of CMBs associated with LA in AD has been lacking. This study was performed to determine frequency and topographic preponderance of CMBs according to severity of LA in AD and compare the cognition and behavior of the AD patients according to severity of LA in AD, also. •101 AD patients were classified in three groups as patients with minimal LA (n=55), moderate LA (n=30) and with severe LA (n=16).•CMBs were counted using mainly 1.5 Tesla SWI (n=90) and gradient-echo (n=10) imaging•The Microbleed Anatomical Rating Scale (MARS) was used to localize each CMB location.•Leukoaraiosis was rated on T2-weighted MRI using the CREDOS white matter hyperintensity visual rating scale.•Numbers and location of CMBs in moderate to severe LA group were statistically compared with those of CMBs in minimal LA group.•Moreover, we compared neuropsychology between the two groups by Seoul Neuropsychological Battery-1 •Total CMBs in moderate to severe LA group (CMBs = 77) was significantly more than CMBs (CMBs=32) in minimal LA group (P=0.024*, t-test)•There is not distribution predominance of CMBs in AD according to leukoaraiosis (P=0.775, Chi-square test)•There is no statistically significant cognitive differences between two groups. •As LA progresses, total number of CMBs increases without affecting cognition and behavior in AD patients and these findings suggest there is no distribution predominance of CMBs in AD according to leukoaraiosis

Leukoaraiosis Is Associated With a Decline in Language Abilities in Chronic Aphasia

Background. A fraction of stroke survivors with chronic aphasia experience declines in language abilities over time, but the reason for this remains unclear. Objective. To evaluate the effect of leukoaraiosis on baseline aphasia severity and long-term changes in aphasia severity. This study directly compares the predictive capacity of leukoaraiosis severity to that of lesion damage, a factor known to account for a substantial proportion of variance in the degree of language impairment and recovery. Methods. Using a longitudinal database of behavioral and neuroimaging data from 35 individuals in the chronic stage of recovery after a single-event left-hemisphere stroke (9 females, mean stroke age = 55.8 ± 9.1 years, mean months poststroke at initial evaluation = 36.3 ± 40.8), we examined 2 lines of inquiry: (1) to what extent does leukoaraiosis severity at initial evaluation predict aphasia severity and (2) to what extent does leukoaraiosis severity at initial evaluation predict longitudinal change in aphasia severity. Participants underwent high-resolution magnetic resonance imaging for the purpose of lesion volume analysis and leukoaraiosis severity rating. Biographical information was also considered. Results. Lesion volume and time poststroke at initial assessment best predicted initial aphasia severity (adjusted R2 = 0.37). Leukoaraiosis severity and initial aphasia severity significantly predicted decline in language abilities at follow-up, accounting for approximately one-third of the variance (adjusted R2 = 0.33). More severe leukoaraiosis was associated with a 4.3 odds increase of decline. Conclusions. Leukoaraiosis is a significant risk factor for declining language abilities in aphasia and should be considered for better identification of individuals at risk for long-term decline, which can guide clinical decision making.

Cognitive Impairment and Treatment Compliance in Patients with Chronic Heart Failure

Objectives. To identify the risk factors for the development of cognitive impairments and the low treatment compliance seen in patients with chronic heart failure (CHF). Materials and methods. A total of 157 patients with CHF and 32 control subjects took part in the study. Neuropsychological investigations were carried out using a 30-min set of tests recommended by the NINDS-Canadian Stroke Standards – echocardioscopy, brain MRI scans, and cognitive event-related potentials (ERP) – along with assessment of treatment compliance. Results and conclusions. Treatment regime violations were seen in 62% of cases. Decreases in compliance were associated with increases in the severity of subcortical (frontal lobes) and periventricular leukoaraiosis, slowing of decision-taking processes (increases in the latency of the ERP P300 peak), and degradation of test performance for assessment of speech activity, optical-spatial, frontal-dysregulatory functions, and memory. Among patients with low treatment compliance, 58% showed frontal-dysregulatory cognitive disorders, 21% combined disorders, and 40% amnestic disorders. Risk factors for progression of cognitive disorders and low treatment compliance were a reduced fractional output and the restrictive type of diastolic cardiac dysfunction.

Factors Associated with Leukoaraiosis Severity in Acute Stroke Patients

Objective: Age-related cerebral white matter abnormalities, commonly termed leukoaraiosis (LA), are frequent manifestation of cerebral microvascular disease. Aging and hypertension are well linked to LA. We compared additional vascular risk factors and socioeconomic factors with LA severity in acute stroke patients. Methods: We analyzed 271 patients with acute ischemic or hemorrhagic stroke from a hospital registry. We collected clinical and socioeconomic data prospectively with a standardized questionnaire during acute stroke hospitalization. We scored LA severity on all available head computed tomography and magnetic resonance imaging (MRI) scans with the Wahlund LA scale. Mean response modeling analyzed for associations between LA severity and multiple potential predictors. Results: Among 238 patients with CT LA scores, ageing and history of hypertension emerged as independent predictors of LA severity in multivariable analysis. Among 186 patients with MRI LA scores, ageing and severe left ventricular hypertrophy emerged as independent predictors of LA severity in multivariable analysis. We did not find an independent significant association between LA severity and the other factors we tested. Conclusions: Our study confirms the association of LA severity with ageing, and with hypertension. However, other vascular and socioeconomic factors we tested were not independently associated with LA severity.

Impact of Leukoaraiosis Severity on the Association of Time to Successful Reperfusion with 90-Day Functional Outcome After Large Vessel Occlusion Stroke.

The chance for a favorable outcome after mechanical thrombectomy (MT) for large vessel occlusion stroke decreases with the symptom onset-to-reperfusion time (OTR). Patients with severe leukoaraiosis are at increased risk for a poor outcome after MT. However, whether leukoaraiosis modulates to the association between OTR and 90-day functional outcome is uncertain. We retrospectively analyzed 144 consecutive patients with successful (TICI ≥ 2b/3) MT for anterior circulation large vessel occlusion within 24h form OTR between January 2012 to November 2016. Leukoaraiosis was dichotomized to absent-to-mild (van Swieten scale score 0-2) versus moderate-to-severe (3-4) as assessed on admission head CT. Multiple linear, logistic, and ordinal regression analyses were used to determine the association between leukoaraiosis, OTR, and 90-day modified Rankin Scale (mRS) score, after adjustment for pertinent covariates. Leukoaraiosis was independently associated with theOTR on multivariable linear regression (p = 0.003). The association between OTR and 90-day outcome depended on the degree of pre-existing leukoaraiosis burden as shown by a significant leukoaraiosis-by-OTR interaction on multivariable logistic regression (OR 0.76, 95% CI 0.58-0.98, p = 0.037) and multivariable ordinal regression (OR 0.87, 95% CI 0.78-0.97, p = 0.011). Pre-existing leukoaraiosis is associated with the 90-day functional outcome after successful reperfusion and impacts the association between the OTR and 90-day mRS among patients undergoing MT. Patients with high leukoaraiosis burden need to present earlier than patients with low leukoaraiosis burden for a similar favorable outcome. Pending confirmation, these results may have important implications for optimizing patient selection for acute stroke therapies.

Leukoaraiosis Predicts Short-term Cognitive But not Motor Recovery in Ischemic Stroke Patients During Rehabilitation

Background: Leukoaraiosis has been shown to impact functional outcomes after acute ischemic stroke. However, its association with domain specific recovery after ischemic stroke is uncertain. We sought to determine whether pre-existing leukoaraiosis is associated with short-term motor and cognitive recovery after stroke. Methods: We retrospectively studied ischemic stroke patients admitted to acute inpatient rehabilitation (AIR) between January 2013 and September 2015. Patient baseline characteristics, infarct volume, prestroke modified Rankin Scale, stroke cause, rehabilitation length of stay, and Functional Independence Measure (FIM) scores were recorded. Leukoaraiosis severity was graded on brain magnetic resonance imaging using the Fazekas scale. Multiple linear regression was used to determine factors independently associated with the total, cognitive, and motor FIM scores at AIR discharge, respectively. Results: Of 1600 ischemic stroke patients screened, 109 patients were included in the final analysis. After adjustment, the initial National Institute of Health Stroke Scale (β −0.541, confidence interval [CI] −0.993 to −0.888; P = 0.020) and pre-existing leukoaraiosis severity (β −1.448, CI −2.861 to −0.034; P = 0.045) independently predicted the total FIM score. Domain specific analysis showed that infarct volume (β −0.012, CI −0.019 to −0.005; P = 0.002) and leukoaraiosis severity (β −0.822, CI −1.223 to −0.410; P = 0.0001) independently predicted FIM cognitive scores at discharge from AIR. Leukoaraiosis did not predict FIM motor score (P = 0.17). Conclusions: Leukoaraiosis severity is an independent predictor of total and cognitive, but not motor FIM scores after AIR for acute ischemic stroke. This highlights that leukoaraiosis affects poststroke recovery in a domain specific fashion, information that may aid counseling of patients and families as well as tailor rehabilitative efforts.

Leukoaraiosis severity predicts rate of decline in primary progressive aphasia

ABSTRACTBackground: The rate of decline in language in primary progressive aphasia (PPA) is highly variable and difficult to predict at baseline. The severity of diffuse white matter disease (leukoaraiosis), a marker of overall brain health, may substantially influence the rate of decline.Aims: To test the hypothesis that leukoaraiosis is associated with a steeper decline in naming in PPA.Methods and procedures: In this longitudinal, observational study, 29 individuals with PPA (all variants) were administered the Boston Naming Test (BNT) at baseline and 1 year later. Two raters evaluated leukoaraiosis on baseline MRI, using the Cardiovascular Health Study scale. We evaluated the effects of leukoaraiosis severity, age, education, and baseline BNT on decline measured by change in BNT accuracy with multivariable linear regression. We also evaluated the effects of these variables on the dichotomized outcome of faster decline in BNT (worst 50%) versus slower decline (best 50%) using logistic regression.Outcomes and results: Taken together, leukoaraiosis, age, education, and baseline BNT score predicted change in BNT score (F(3, 25) = 8.12; p = 0.0006). Change in BNT score was predicted by severity of leukoaraiosis (t = −3.81; p = 0.001) and education (t = −2.45; p = 0.022), independently of the other variables. When we dichotomized outcome into upper 50th percentile versus lower 50th percentile (faster decline), faster decline was predicted by all variables together (chi-squared = 13.91; p = 0.008). However, only leukoaraiosis independently predicted outcome (OR = 2.80; 95%CI: 1.11 to 7.03). For every 1 point increase on the CHS rating scale, there was 2.8 times higher chance of showing faster decline in naming.Conclusion: Severity of leukoaraiosis is associated with steeper decline in naming in PPA. This imaging marker can aide in prognosis and planning by caregivers and stratification of participants in clinical trials.

Leukoaraiosis is an independent predictor of intracranial hemorrhage in patients with atrial fibrillation.

We evaluated the predictive value of several clinical, radiological and laboratory parameters on the risk of predict intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF). We conducted a case-control study on a consecutive hospital based series of patients with AF and ICH. A random sample of subjects with AF without ischemic or hemorrhagic stroke was selected from the same hospital in the same period to perform as the control group, with a ratio of two controls per case. All patients underwent the same evaluation protocol. Patients without neuroimaging exams were excluded. During the study period we identified 37 subjects with AF and ICH. 74 subjects without stroke events were randomly chosen among subjects with AF. Among cases 56.8% were female; mean age was 83.1years. Patients with ICH were more often on anticoagulant therapy (75.7%), compared with controls (45.9%; p = 0.0002). On CT scans, cases had a greater severity of leukoaraiosis at the Blennow scale (p < 0.0001) and a higher frequency of lacunar infarcts (p = 0.006). No significant association was found between MRI parameters or the HAS-BLED score and the occurrence of ICH. CT scan is more useful than MRI and HAS-BLED score to predict ICH in patients with AF on antithrombotic therapy.

Abstract WP64: The Effect of Leukoaraiosis on Functional Outcome After Thrombectomy

Introduction: The chance for a favorable outcome after mechanical thrombectomy (MT) for large vessel occlusion stroke decreases with the symptom onset-to-reperfusion time (OTR). Patients with severe leukoaraiosis are at increased risk for a poor outcome after MT. However, whether leukoaraiosis modulates to the association between OTR and 90-day functional outcome is uncertain. Methods: We retrospectively analyzed 144 consecutive patients with successful (TICI ≥2b/3) MT for anterior circulation LVO within 24 hours form OTR between January 2012 to November 2016. Leukoaraiosis was dichotomized to absent-to-mild (van Swieten scale score 0-2) versus moderate-to-severe (3-4) as assessed on admission head CT. Multiple linear, logistic, and ordinal regression analyses were used to determine the association between leukoaraiosis, OTR and 90-day modified Rankin Scale (mRS) score, after adjustment for pertinent covariates. Results: Leukoaraiosis was independently associated with OTR on multivariable linear regression ( p =0.003). The association between OTR and 90-day outcome depended on the degree of preexisting leukoaraiosis burden as shown by a significant leukoaraiosis-by-OTR interaction on multivariable logistic regression (OR 0.76, 95%-CI 0.58-0.98, p =0.037) and multivariable ordinal regression (OR 0.87, 95%-CI 0.78-0.97, p =0.011). Conclusions: The severity of pre-existing leukoaraiosis is associated with 90-day functional outcome and modulates the association between the OTR and 90-day mRS among patients undergoing MT within 24 hours from last known well. If confirmed, our results may have important implications for optimizing patient selection for acute stroke therapies.

Abstract WP463: Baseline Leukoaraiosis Does Not Modify Clinical Outcomes in Patients With Spontaneous Intracerebral Hemorrhage

Background: Prior studies have suggested that baseline leukoaraiosis before ICH may be associated with high mortality, initial large hematoma volume, and may be an independent risk factor for worse outcomes after ICH, yet leukoaraiosis is not included in prognostic criteria for ICH. We hypothesized that increased leukoaraiosis burden at baseline would be associated with worse outcomes in patients enrolled in the Safety of Pioglitazone for Hematoma Resolution in ICH (SHRINC) trial. Methods: Patients enrolled in SHRINC had a baseline brain MRI per protocol. We performed a retrospective analysis of leukoaraiosis measured on baseline MRI. Baseline leukoaraiosis scoring was measured using the Fazekas score (FS). Patients were stratified into two groups based on FS, none-mild (FS 0-1) and moderate-severe (FS 2-3). FS was evaluated as a treatment modifier for mRS, NIHSS and Barthel Index. Comparisons were performed by Chi-square, Fisher’s Exact or Wilcoxon rank sum, linear or logistic regression models were developed to test FS as a treatment effect modifier on outcomes. Results: A total of 78 subjects had baseline MRIs (37 PIO, 41 Placebo) suitable to determine FS. There was no difference in important prognostic variables between the two groups (Table). There was no significant interaction between FS and treatment group at 90 or 180 days regarding good outcome, NIHSS, Barthel index (p= 0.18, 0.31, 0.40, respectively). Conclusions: Our analysis revealed that the presence of baseline moderate to severe leukoaraiosis was not associated with baseline presentation nor treatment effect on outcomes. Our findings raise the question whether our traditional outcome measures are able to detect deficit due to leukoaraisosis and future studies should consider outcomes measures which can better quantify deficits attributable to leukoaraiosis.