Photo Credit: Mr. Suphachai Praserdumrongchai

In a study of thrombectomy-treated anterior circulation strokes, researchers found that extensive white matter hyperintensity (WMH) burden strongly correlated with poor pial collaterals in embolic subtypes (cardioembolism and tandem lesions), while no such association was observed in strokes caused by intracranial atherosclerosis.

The following is a summary of “White matter hyperintensity burden and collateral circulation in acute ischemic stroke with large artery occlusion,” published in the January 2024 issue of Neurology by Chen et al.

Researchers conducted a  retrospective study exploring how white matter hyperintensity (WMH) burden relates to pial collaterals in anterior circulation large artery occlusion strokes treated with thrombectomy, focusing on stroke subtype variations.

They screened patients undergoing mechanical thrombectomy (December 2019 to June 2022). WMH burden was assessed using the Fazekas scale, and pial collaterals were categorized as poor (0–2) or good (3–4) based on the Higashida score. A multivariable analysis determined the relationship between WMH burden and pial collaterals. Subgroup analyses explored associations in stroke subtypes, cardioembolism (CE), tandem lesions (TLs), and intracranial atherosclerosis (ICAS).

The results showed 47.8% (274/573) had poor pial collaterals. Extensive WMH burden (Fazekas score of 3–6) strongly correlated with poor collaterals [aOR 3.04, 95% CI 1.70–5.46, P<0.001]. Predictors of poor collaterals included ICAS-related occlusion (aOR 0.26, 95% CI 0.09–0.76, P=0.014), female sex (aOR 0.63, 95% CI 0.41–0.96, P=0.031), and baseline Alberta Stroke Program Early Computed Tomography scores (aOR 0.80, 95% CI 0.74–0.88, P<0.001). An interaction between extensive WMH burden and stroke subtypes predicted poor collaterals (P=0.001), being pronounced for CE (aOR 2.30, 95% CI 1.21–4.37) and TLs (aOR 5.09, 95% CI 2.32–11.16), but absent in ICAS (aOR 1.24, 95% CI 0.65–2.36).

They concluded that in thrombectomy-treated anterior circulation strokes, WMH burden linked to poor pial collaterals in embolic subtypes (CE & TLs), not ICAS.

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03517-8