Huiqiao Tian1, Mark W Parsons2, Christopher R Levi2, Longting Lin2, Richard I Aviv2, Neil J Spratt2, Kenneth S Butcher2, Min Lou2, Timothy J Kleinig2, Andrew Bivard2. 1. From 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. 2. From 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.
Abstract
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.
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 strokepatients 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 strokepatients 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.
Authors: R McDonough; P Cimflova; N Kashani; J M Ospel; M Kappelhof; N Singh; A Sehgal; N Sakai; J Fiehler; M Chen; M Goyal Journal: AJNR Am J Neuroradiol Date: 2021-08-19 Impact factor: 4.966
Authors: Chushuang Chen; Mark W Parsons; Christopher R Levi; Neil J Spratt; Longting Lin; Timothy Kleinig; Kenneth Butcher; Xin Cheng; Qiang Dong; Billy O'Brien; Richard I Avivi; Martin Krause; P N Sylaja; Philip Choi; Sandeep Bhuta; Congguo Yin; Jianhong Yang; Peng Wang; Weiwen Qiu; Andrew Bivard Journal: Front Neurol Date: 2021-01-13 Impact factor: 4.003
Authors: Nerea Arrarte Terreros; Agnetha A E Bruggeman; Isabella S J Swijnenburg; Laura C C van Meenen; Adrien E Groot; Jonathan M Coutinho; Yvo B W E M Roos; Bart J Emmer; Ludo F M Beenen; Ed van Bavel; Henk A Marquering; Charles B L M Majoie Journal: J Neurointerv Surg Date: 2021-05-13 Impact factor: 8.572