BACKGROUND: Severe middle cerebral artery stroke (MCA) is associated with a high rate of morbidity and mortality. We assessed the hypothesis that patient-specific variables may be associated with outcomes. We also sought to describe under-recognized patient-centered outcomes. METHODS: A consecutive, multi-institution, retrospective cohort of adult patients (≤70 years) was established from 2009 to 2011. We included patients with NIHSS score ≥15 and infarct volume ≥60 mL measured within 48 h of symptom onset. Malignant edema was defined as the development of midline brain shift of ≥5 mm in the first 5 days. Exclusion criterion was enrollment in any experimental trial. A univariate and multivariate logistic regression analysis was performed to model and predict the factors related to outcomes. RESULTS: 46 patients (29 female, 17 male; mean age 57.3 ± 1.5 years) met study criteria. The mortality rate was 28% (n = 13). In a multivariate analysis, only concurrent anterior cerebral artery (ACA) involvement was associated with mortality (OR 9.78, 95% CI 1.15, 82.8, p = 0.04). In the malignant edema subgroup (n = 23, 58%), 4 died (17%), 7 underwent decompressive craniectomy (30%), 7 underwent tracheostomy (30%), and 15 underwent gastrostomy (65%). CONCLUSIONS: Adverse outcomes after severe stroke are common. Concurrent ACA involvement predicts mortality in severe MCA stroke. It is useful to understand the incidence of life-sustaining procedures, such as tracheostomy and gastrostomy, as well as factors that contribute to their necessity.
BACKGROUND: Severe middle cerebral artery stroke (MCA) is associated with a high rate of morbidity and mortality. We assessed the hypothesis that patient-specific variables may be associated with outcomes. We also sought to describe under-recognized patient-centered outcomes. METHODS: A consecutive, multi-institution, retrospective cohort of adult patients (≤70 years) was established from 2009 to 2011. We included patients with NIHSS score ≥15 and infarct volume ≥60 mL measured within 48 h of symptom onset. Malignant edema was defined as the development of midline brain shift of ≥5 mm in the first 5 days. Exclusion criterion was enrollment in any experimental trial. A univariate and multivariate logistic regression analysis was performed to model and predict the factors related to outcomes. RESULTS: 46 patients (29 female, 17 male; mean age 57.3 ± 1.5 years) met study criteria. The mortality rate was 28% (n = 13). In a multivariate analysis, only concurrent anterior cerebral artery (ACA) involvement was associated with mortality (OR 9.78, 95% CI 1.15, 82.8, p = 0.04). In the malignant edema subgroup (n = 23, 58%), 4 died (17%), 7 underwent decompressive craniectomy (30%), 7 underwent tracheostomy (30%), and 15 underwent gastrostomy (65%). CONCLUSIONS: Adverse outcomes after severe stroke are common. Concurrent ACA involvement predicts mortality in severe MCA stroke. It is useful to understand the incidence of life-sustaining procedures, such as tracheostomy and gastrostomy, as well as factors that contribute to their necessity.
Authors: Eric E Smith; Nandavar Shobha; David Dai; Daiwai M Olson; Mathew J Reeves; Jeffrey L Saver; Adrian F Hernandez; Eric D Peterson; Gregg C Fonarow; Lee H Schwamm Journal: Circulation Date: 2010-09-27 Impact factor: 29.690
Authors: S E Kasner; A M Demchuk; J Berrouschot; E Schmutzhard; L Harms; P Verro; J A Chalela; R Abbur; H McGrade; I Christou; D W Krieger Journal: Stroke Date: 2001-09 Impact factor: 7.914
Authors: José Castillo; Rogelio Leira; María M García; Joaquín Serena; Miguel Blanco; Antoni Dávalos Journal: Stroke Date: 2004-01-15 Impact factor: 7.914
Authors: J Marc Simard; Mingkui Chen; Kirill V Tarasov; Sergei Bhatta; Svetlana Ivanova; Ludmila Melnitchenko; Natalya Tsymbalyuk; G Alexander West; Volodymyr Gerzanich Journal: Nat Med Date: 2006-03-19 Impact factor: 53.440
Authors: Eric Jüttler; Stefan Schwab; Peter Schmiedek; Andreas Unterberg; Michael Hennerici; Johannes Woitzik; Steffen Witte; Ekkehart Jenetzky; Werner Hacke Journal: Stroke Date: 2007-08-09 Impact factor: 7.914
Authors: Nils Hecht; Hermann Neugebauer; Ingo Fiss; Alexandra Pinczolits; Peter Vajkoczy; Eric Jüttler; Johannes Woitzik Journal: J Cereb Blood Flow Metab Date: 2017-06-30 Impact factor: 6.200
Authors: Brian P Walcott; Hooman Kamel; Brandyn Castro; W Taylor Kimberly; Kevin N Sheth Journal: J Stroke Cerebrovasc Dis Date: 2013-10-06 Impact factor: 2.136
Authors: A D Horsch; J W Dankbaar; T A Stemerdink; E Bennink; T van Seeters; L J Kappelle; J Hofmeijer; H W de Jong; Y van der Graaf; B K Velthuis Journal: AJNR Am J Neuroradiol Date: 2016-01-21 Impact factor: 3.825
Authors: C D Streib; S Rangaraju; D T Campbell; D G Winger; S L Paolini; A J Zhang; B T Jankowitz; A P Jadhav; T G Jovin Journal: AJNR Am J Neuroradiol Date: 2018-12-27 Impact factor: 3.825
Authors: Haifa M Algethamy; Afnan Samman; Saleh S Baeesa; Mohammed A Almekhlafi; Yousef A Al Said; Ahmed Hassan Journal: Neurosciences (Riyadh) Date: 2017-07 Impact factor: 0.906