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Influence of occlusion site and baseline ischemic core on outcome in patients with ischemic stroke
Huiqiao Tian1, Mark W Parsons2, Christopher R Levi2
1From the Department of Neurology (H.T., M.W.P., C.R.L., L.L., N.J.S., A.B.), John Hunter Hospital, University of Newcastle, Australia; Department of Medical Imaging, Division of Neuroradiology (R.I.A.), Sunnybrook Health Sciences Center and University of Toronto; Division of Neurology, Department of Medicine (K.S.B.), University of Alberta, Edmonton, Canada; Department of Neurology (M.L.), the Second Affiliated Hospital of Zhejiang University, Hangzhou, China; and Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia. Huiqiao.tian@uon.edu.au.
Insights
Patients with distal occlusions in ischemic stroke had better outcomes than those with M1 occlusions. However, baseline ischemic core size was a stronger predictor of functional outcome than occlusion location.
Area of Science:
- Neurology
- Stroke Research
- Neuroimaging
Background:
- Stroke is a leading cause of disability.
- Identifying predictors of functional outcome is crucial for treatment.
- Occlusion location and ischemic core size are potential factors influencing outcomes.
Purpose of the Study:
- To assess clinical outcomes in ischemic stroke patients based on occlusion location.
- To determine if occlusion location independently predicts outcomes.
- To test the relationship between occlusion location and baseline ischemic core size.
Main Methods:
- Analysis of a prospectively collected cohort of thrombolysis-eligible ischemic stroke patients.
- Multimodal CT pretreatment data from the International Stroke Perfusion Imaging Registry.
- Logistic regression to predict excellent (mRS 0-1) and favorable (mRS 0-2) 90-day outcomes.
Main Results:
- Patients with distal occlusions (M2, M3, ACA, PCA) showed higher rates of excellent (55% vs 37%) and favorable (73% vs 50%) outcomes compared to M1 occlusions.
- Baseline ischemic core was a stronger predictor of outcomes (AUC 0.83-0.86) than occlusion location (AUC 0.64-0.70).
- No significant interaction was found between occlusion location and ischemic core size (p=0.798).
Conclusions:
- Distal occlusions in ischemic stroke are associated with better functional outcomes than M1 occlusions.
- Baseline ischemic core size is a more potent predictor of 90-day functional outcome than occlusion location.
- The predictive value of ischemic core size for outcome is consistent across different occlusion locations.
Objective:
We assessed patient clinical outcomes based on occlusion location, focusing on distal occlusions to understand if occlusion location was an independent predictor of outcome, and tested the relationship between occlusion location and baseline ischemic core, a known predictor of modified Rankin Scale (mRS) score at 90 days.
Methods:
We analyzed a prospectively collected cohort of thrombolysis-eligible ischemic stroke patients from the International Stroke Perfusion Imaging Registry who underwent multimodal CT pretreatment. For the primary analysis, logistic regression was used to predict the effect of occlusion location and ischemic core on the likelihood of excellent (mRS 0-1) and favorable (mRS 0-2) 90-day outcomes.
Results:
This study included 945 patients. The rates of excellent and favorable outcome in patients with distal occlusion (M2, M3 segment of middle cerebral artery, anterior cerebral artery, and posterior cerebral artery) were higher than M1 occlusions (mRS 0%-1%, 55% vs 37%; mRS 0%-2%, 73% vs 50%, p < 0.001). Vessel occlusion location was not a strong predictor of outcomes compared to baseline ischemic core (area under the curve, mRS 0-1, 0.64 vs 0.83; mRS 0-2, 0.70 vs 0.86, p < 0.001). There was no interaction between occlusion location and ischemic core (interaction coefficient 1.00, p = 0.798).
Conclusions:
Ischemic stroke patients with a distal occlusion have higher rate of excellent and favorable outcome than patients with an M1 occlusion. The baseline ischemic core was shown to be a more powerful predictor of functional outcome than the occlusion location, but the relationship between ischemic core and outcome does not different by occlusion locations.
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