Achala S Vagal1, Heidi Sucharew2, Shyam Prabhakaran3, Pooja Khatri4, Tudor Jovin5, Patrik Michel6, Max Wintermark6. 1. Department of Radiology, University of Cincinnati (UC) College of Medicine and Comprehensive Stroke Center at UC Neuroscience Institute, Cincinnati, OH, USA Achala.Vagal@uchealth.com. 2. Department of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 3. Department of Neurology, Northwestern University, Evanston, IL, USA. 4. Department of Neurology, University of Cincinnati (UC) College of Medicine and Comprehensive Stroke Center at UC Neuroscience Institute, Cincinnati, OH, USA. 5. Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA. 6. Neurology Centre Hospitalier Universitaire, Lausanne, Switzerland; Department of Radiology, Stanford University, Palo Alto, CA, USA.
Abstract
INTRODUCTION: Knowledge of whether final infarct volume (FIV) predicts disability after mild stroke is limited. We sought to determine if FIV could differentiate good versus poor outcome after mild stroke. METHODS: We retrospectively identified 65 patients with mild stroke (National Institutes of Health Stroke Scale≤5) in a multicenter registry of 2453 patients. We evaluated associations between FIV and clinical outcome and evaluated the optimal FIV threshold that discriminated favorable (modified Rankin scale (mRS) 0-1) versus poor (mRS 2-6) outcome. RESULTS: The FIV cut-point of 20 mL differentiated favorable and poor outcomes (area under curve (AUC) 0.73, 95% confidence interval: 0.58-0.88). Favorable outcome was observed in 37/45 (82%) with FIV<20 mL, compared to 5/14 (36%) with FIV≥20 mL (p<0.01). FIV≥20 mL remained strongly associated with poor outcome independent of age, gender, stroke severity, Alberta Stroke Program Early CT Score (ASPECTS), and proximal arterial occlusion. CONCLUSION: In our small sample size, an FIV of 20 mL best differentiated between the likelihood of good versus poor outcome in patients with mild stroke. Further validation of infarct volume as a surrogate marker in mild stroke is warranted.
INTRODUCTION: Knowledge of whether final infarct volume (FIV) predicts disability after mild stroke is limited. We sought to determine if FIV could differentiate good versus poor outcome after mild stroke. METHODS: We retrospectively identified 65 patients with mild stroke (National Institutes of Health Stroke Scale≤5) in a multicenter registry of 2453 patients. We evaluated associations between FIV and clinical outcome and evaluated the optimal FIV threshold that discriminated favorable (modified Rankin scale (mRS) 0-1) versus poor (mRS 2-6) outcome. RESULTS: The FIV cut-point of 20 mL differentiated favorable and poor outcomes (area under curve (AUC) 0.73, 95% confidence interval: 0.58-0.88). Favorable outcome was observed in 37/45 (82%) with FIV<20 mL, compared to 5/14 (36%) with FIV≥20 mL (p<0.01). FIV≥20 mL remained strongly associated with poor outcome independent of age, gender, stroke severity, Alberta Stroke Program Early CT Score (ASPECTS), and proximal arterial occlusion. CONCLUSION: In our small sample size, an FIV of 20 mL best differentiated between the likelihood of good versus poor outcome in patients with mild stroke. Further validation of infarct volume as a surrogate marker in mild stroke is warranted.
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