Seyedmehdi Payabvash1, Guido J Falcone2, Gordon K Sze1, Abhi Jain3, Lauren A Beslow4, Nils H Petersen2, Kevin N Sheth5, W Taylor Kimberly6. 1. Division of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut. 2. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut. 3. College of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. 4. Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 5. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut. Electronic address: kevin.sheth@yale.edu. 6. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: We aimed to assess the correlation of lesion location and clinical outcome in patients with large hemispheric infarction (LHI). METHODS: We analyzed admission MRI data from the GAMES-RP trial, which enrolled patients with anterior circulation infarct volumes of 82-300 cm3 within 10 hours of onset. Infarct lesions were segmented and co-registered onto MNI-152 brain space. Voxel-wise general linear models were applied to assess location-outcome correlations after correction for infarct volume as a co-variate. RESULTS: We included 83 patients with known 3-month modified Rankin scale (mRS). In voxel-wise analysis, there was significant correlation between admission infarct lesions involving the anterior cerebral artery (ACA) territory and its middle cerebral artery (MCA) border zone with both higher 3-month mRS and post-stroke day 3 and 7 National Institutes of Health Stroke Scale (NIHSS) total score and arm/leg subscores. Higher NIHSS total scores from admission through poststroke day 2 correlated with left MCA infarcts. In multivariate analysis, ACA territory infarct volume (P = .001) and admission NIHSS (P = .005) were independent predictors of 3-month mRS. Moreover, in a subgroup of 36 patients with infarct lesions involving right MCA-ACA border zone, intravenous (IV) glibenclamide (BIIB093; glyburide) treatment was the only independent predictor of 3-month mRS in multivariate regression analysis (P = .016). CONCLUSIONS: Anterior extension of LHI with involvement of ACA territory and ACA-MCA border zone is an independent predictor of poor functional outcome, likely due to impairment of arm/leg motor function. If confirmed in larger cohorts, infarct topology may potentially help triage LHI patients who may benefit from IV glibenclamide. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01794182.
BACKGROUND: We aimed to assess the correlation of lesion location and clinical outcome in patients with large hemispheric infarction (LHI). METHODS: We analyzed admission MRI data from the GAMES-RP trial, which enrolled patients with anterior circulation infarct volumes of 82-300 cm3 within 10 hours of onset. Infarct lesions were segmented and co-registered onto MNI-152 brain space. Voxel-wise general linear models were applied to assess location-outcome correlations after correction for infarct volume as a co-variate. RESULTS: We included 83 patients with known 3-month modified Rankin scale (mRS). In voxel-wise analysis, there was significant correlation between admission infarct lesions involving the anterior cerebral artery (ACA) territory and its middle cerebral artery (MCA) border zone with both higher 3-month mRS and post-stroke day 3 and 7 National Institutes of Health Stroke Scale (NIHSS) total score and arm/leg subscores. Higher NIHSS total scores from admission through poststroke day 2 correlated with left MCA infarcts. In multivariate analysis, ACA territory infarct volume (P = .001) and admission NIHSS (P = .005) were independent predictors of 3-month mRS. Moreover, in a subgroup of 36 patients with infarct lesions involving right MCA-ACA border zone, intravenous (IV) glibenclamide (BIIB093; glyburide) treatment was the only independent predictor of 3-month mRS in multivariate regression analysis (P = .016). CONCLUSIONS: Anterior extension of LHI with involvement of ACA territory and ACA-MCA border zone is an independent predictor of poor functional outcome, likely due to impairment of arm/leg motor function. If confirmed in larger cohorts, infarct topology may potentially help triage LHI patients who may benefit from IV glibenclamide. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01794182.
Authors: Eelco F M Wijdicks; Kevin N Sheth; Bob S Carter; David M Greer; Scott E Kasner; W Taylor Kimberly; Stefan Schwab; Eric E Smith; Rafael J Tamargo; Max Wintermark Journal: Stroke Date: 2014-01-30 Impact factor: 7.914
Authors: Kevin N Sheth; Nils H Petersen; Ken Cheung; Jordan J Elm; Holly E Hinson; Bradley J Molyneaux; Lauren A Beslow; Gordon K Sze; J Marc Simard; W Taylor Kimberly Journal: Stroke Date: 2018-05-22 Impact factor: 7.914
Authors: Kevin N Sheth; Jordan J Elm; Bradley J Molyneaux; Holly Hinson; Lauren A Beslow; Gordon K Sze; Ann-Christin Ostwaldt; Gregory J Del Zoppo; J Marc Simard; Sven Jacobson; W Taylor Kimberly Journal: Lancet Neurol Date: 2016-08-23 Impact factor: 44.182
Authors: Seyedmehdi Payabvash; John C Benson; Andrew E Tyan; Shayandokht Taleb; Alexander M McKinney Journal: J Stroke Cerebrovasc Dis Date: 2017-11-29 Impact factor: 2.136
Authors: J Marc Simard; Kevin N Sheth; W Taylor Kimberly; Barney J Stern; Gregory J del Zoppo; Sven Jacobson; Volodymyr Gerzanich Journal: Neurocrit Care Date: 2014-04 Impact factor: 3.210
Authors: André Kemmling; Michael H Lev; Seyedmehdi Payabvash; Rebecca A Betensky; Jing Qian; Shihab Masrur; Lee H Schwamm Journal: PLoS One Date: 2013-08-07 Impact factor: 3.240
Authors: Anderson M Winkler; Gerard R Ridgway; Matthew A Webster; Stephen M Smith; Thomas E Nichols Journal: Neuroimage Date: 2014-02-11 Impact factor: 6.556