Correlation of White Matter Hyperintensity and Cerebral Microbleed with the Prognosis of Cerebral Infarction Patients After Mechanical Thrombectomy and Recanalization with Acute Anterior Circulation Large Vessel Occlusion
SHANG Dandan
LI Yan
WANG Hao
LIU Jiacheng
FAN Zhenzhen
DU Yanjiao
DUAN Zhihui
Abstract：Objective To investigate the association of white matter hyperintensity(WMH)and cerebral microbleed with outcomes after mechanical thrombectomy in acute cerebral infarction with large vessel occlusion in anterior circulation.Methods Retrospective inclusion of patients with acute anterior circulation ischemic stroke who underwent mechanical thrombectomy and successfully recanalized(modified thrombolysis in cerebral infarction grade 2b/3)admitted to the Department of Neurology of Luoyang Central Hospital Affiliated to Zhengzhou University from January 2019 to December 2021 were retrospectively analyzed.Both head MRI and SWI were perfected before mechanical thrombectomy.The degree of WMH was assessed using the visual Fazekas scale,which was divided into none-mild(Fazekas 0-2),moderate to severe(Fazekas 3-6).Ninety days modified Rankin scale score ≤ 2 was defined as a good functional outcome,conversely the score ≥ 3 was defined as a poor functional outcome.Patients' clinical data was recorded.Then multivariate logistic regression were used to explore the correlation of WMH and cerebral microbleed with the 90 days functional outcome,hemorrhagic transformation and symptomatic intracranial hemorrhage.Results A total of 126 patients were enrolled,which contained 85 cases(67.5％)none to mild white matter hyperintensity,41 cases(32.5％)moderate to severe WMH subjects,37 cases(29.4％)with cerebral microbleed,61 cases(48.4％)with good outcome and 65 cases(51.6％)with poor outcome,20 cases(15.9％)with hemorrhagic transformation and 14 cases(11.1％)with symptomatic intracranial hemorrhage.Compared with the poor outcome group,the good outcome group had lower systolic blood pressure,lower National Institute of Health stroke scale scores,higher baseline diffusion-weighted imaging-alberta stroke program early CT score,shorter onset to recanalization time and moderate to severe WMH,the difference was statistically significant(P＜0.05).Neither the cerebral microbleed burden,nor location had no statistical difference(P＞0.05)in the two groups.On multivariate logistic regression analysis,baseline National Institute of Health stroke scale scores(OR=1.180,95％CI:1.069-1.302,P=0.001),baseline systolic blood pressure(OR=1.029,95％CI:1.010-1.049,P=0.003),onset to recanalization time(OR=1.002,95％CI:1.000-1.004,P=0.043),moderate to severe WMH(OR=2.562,95％CI:1.043-6.292,P=0.040)were independent risk factors for poor 90 days functional outcome after mechanical thrombectomy(P＜0.05).The rate of hemorrhagic transformation was higher in the moderate-severe WMH group(26.8％vs 10.6％,P=0.035),and there was no difference between the two groups in symptomatic intracranial hemorrhage(19.5％vs 7.06％,P=0.075).There were no significant differences between the burden,location of cerebral microbleed and hemorrhagic transformation,symptomatic intracranial hemorrhage(P＞0.05).Conclusion WMH was an independent risk factor for poor functional outcome in the patients of acute cerebral infarction treated WMH in anterior circulation.white matter hyperintensity increased the risk of hemorrhagic transformation.The incidence of symptomatic intracranial hemorrhage increased,but there was no statistical significance.The patients with cerebral microbleed did not increase the risk of poor outcome,hemorrhagic transformation and symptomatic intracranial hemorrhage.
Keywords：large vessel occlusionmechanical thrombectomywhite matter hyperintensitycerebral microbleedoutcome
Publication Date：2025-08-28
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：6( 2900-2905 )