Leukoaraiosis severity and outcomes of endovascular thrombectomy for acute ischemic stroke: a systematic review and meta-analysis.

Background: Endovascular thrombectomy (EVT) is the standard of care for eligible patients with large vessel occlusion (LVO). Yet, little is known regarding the impact of leukoaraiosis (LA) on outcomes following EVT for LVO.

Objective: We conducted a systematic review and meta-analysis to investigate the impact of LA on outcomes following EVT.

Methods: A literature search was performed in PubMed, Embase, Scopus, and Web of Science, from inception until January 7, 2024. Patients were categorized into two groups based on the level of LA: one with absent to mild LA (AMLA) and the other with moderate to severe LA (MSLA). The primary outcome of interest was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), thrombolysis in cerebral infarction (TICI) score 2b-3, and mortality. Using R software, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI).

Results: We included 18 studies with 7022 patients. MSLA was associated with lower rates of mRS 0-2 (OR, 0.32 [95% CI: 0.26-0.41]; p < 0.001), similar rates of TICI 2b-3 (OR, 0.91 [95% CI: 0.77-1.07]; p = 0.235) and sICH (OR, 1.18 [95% CI: 0.92-1.51]; p = 0.202), and greater rates of mortality (OR, 2.89 [95% CI: 2.38-3.52]; p < 0.001) compared to AMLA.

Conclusions: MSLA is associated with lower rates of mRS 0-2 and worse safety outcomes following EVT for LVO, despite similar rates of TICI 2b-3. Future prospective studies should further study MSLA as a prognosticator following EVT. Conclusions: Question Does the severity of LA impact functional and safety outcomes following EVT for acute ischemic stroke due to LVO? Findings Moderate-to-severe LA was associated with lower rates of good functional outcome and higher mortality following EVT, despite similar rates of successful reperfusion and sICH. Clinical relevance LA severity is an independent prognostic factor in EVT outcomes. Identifying patients with moderate-to-severe LA can aid in risk stratification and post-procedural management, optimizing individualized stroke treatment and follow-up strategies.