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Published on: September 25, 2019
Association of baseline core volume and early midline shift in acute stroke patients with a large ischaemic core
Ting-Yu Yi1, Yan-Min Wu1, Ding-Lai Lin1
1Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China.
Insights
A large baseline infarct core volume, specifically over 40 ml with relative cerebral blood flow less than 15%, predicts early midline shift in stroke patients undergoing endovascular treatment.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Midline shift (MLS) is a significant complication in patients with large infarct core (LIC).
- Baseline infarct core volume is a potential predictor of early MLS.
- Understanding this relationship is crucial for managing acute stroke patients.
Purpose of the Study:
- To investigate the association between baseline infarct core volume and the presence of early midline shift.
- To identify specific infarct core volume thresholds that predict early MLS.
Main Methods:
- Retrospective analysis of patients with acute intracranial large artery occlusion and pretreatment relative cerebral blood flow (rCBF) <30% volume ≥50 ml on CT perfusion (CTP).
- Evaluation of early MLS presence within 48 hours as the primary endpoint.
- Multivariable regression analysis to assess the association between baseline infarct core volume (ICV) and early MLS.
Main Results:
- 29.5% of 95 included patients experienced early MLS.
- A larger baseline rCBF < 15% volume was significantly associated with early severe MLS (46 ml vs. 29 ml).
- Baseline rCBF < 15% volume demonstrated superior predictive accuracy for early MLS compared to rCBF < 30% volume (AUC 0.74 vs. 0.64).
- An infarct core volume ≥40 ml based on rCBF < 15% was significantly associated with early MLS (OR 4.34).
Conclusions:
- Pretreatment infarct core volume exceeding 40 ml, defined by rCBF < 15%, is a valuable predictor of early MLS in acute stroke patients treated with EVT.
- This finding aids in risk stratification and management planning for stroke patients.
Background:
Midline shift (MLS) is troublesome problem that may occur in patients with a large infarct core (LIC) and may be related to the baseline infarct core volume. The purpose of this study was to explore the relationship between baseline infarct core volume and early MLS presence.
Materials And Methods:
Patients with acute intracranial large artery occlusion and a pretreatment relative cerebral blood flow (rCBF) <30% volume ≥50 ml on CT perfusion (CTP) were included, clinical outcomes following endovascular treatment (EVT) were retrospectively analyzed. The primary endpoint was MLS within 48 h (early MLS presence). The association between baseline ICV and early MLS presence was evaluated with multivariable regression.
Results:
Ultimately, 95 patients were included, and 29.5% (28/95) of the patients had early MLS. The number of patients with a baseline rCBF < 15% volume (median [interquartile range], 46 [32-60] vs. 29 [19-40]; P < 0.001) was significantly larger in the early severe MLS presence group. A baseline rCBF < 15% volume showed significantly better predictive accuracy for early MLS presence than an rCBF < 30% volume (area under the curve, 0.74 vs. 0.64, P = 0.0023). In addition, an rCBF < 15% volume ≥40 ml (odds ratio, 4.34 [95% CI, 1.571-11.996]) was associated with early MLS presence after adjustment for sex, age, baseline National Institutes of Health Stroke Scale score, onset-to-recanalization time.
Conclusion:
In patients with an acute LIC following EVT, a pretreatment infarct core volume > 40 ml based on an rCBF < 15% showed good predictive value for early MLS occurrence.
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