Johanna Ospel1,2, Arnuv Mayank1, Wu Qiu1, Mohammed Almekhlafi1,3, Bijoy Menon1,3, Ryan McTaggart4, Raul Nogueira5, Andrew Demchuk1,3, Manish Joshi1,3, Charlotte Zerna1, Rene Chapot6, Aditya Bharatha7, Ashutosh Jadhav8, Simon Nagel9, Alexandre Poppe10, Michael Tymianski11, Michael Hill1,3, Mayank Goyal12,13. 1. Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada. 2. Radiology, University Hospital of Basel, Basel, Switzerland. 3. Radiology, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada. 4. Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI, USA. 5. Neurology, Emory University School of Medicine, Atlanta, GA, USA. 6. Neuroradiology, Alfred Krupp Krankenhaus Essen, Essen, Germany. 7. St. Michael's Hospital, Toronto, Canada. 8. University of Pittsburgh, Pittsburgh, USA. 9. Neurology, University Hospital Heidelberg, Heidelberg, Germany. 10. Universite de Montreal, Montreal, Canada. 11. NoNo Inc., Toronto, Canada. 12. Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada. mgoyal@ucalgary.ca. 13. Radiology, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada. mgoyal@ucalgary.ca.
Abstract
PURPOSE: There are few data on the prevalence and impact of isolated deep grey matter infarction in acute stroke. In this study, we aimed to investigate the prevalence of isolated deep grey matter infarcts and their impact on the outcome. METHODS: Infarcts on 24-h follow-up imaging (non-contrast head CT or diffusion-weighted MRI) in the ESCAPE-NA1 trial were categorized into predominantly deep grey matter infarcts vs. infarcts involving additional territories ("other infarcts"). Total infarct volume was manually segmented. Baseline characteristics and proportions of good outcome (primary outcome, defined as modified Rankin Score [mRS] 0-2 at 90 days), excellent outcome (mRS 0-1) and mortality were compared between patients with and without predominantly deep grey matter infarcts. Multivariable logistic regression with adjustment for baseline variables and total infarct volume was used to determine a possible association of predominantly deep grey matter infarcts and clinical outcome. RESULTS: Predominantly deep grey matter infarcts were seen in 316/1026 patients (30.8%). Compared to other patients, their ASPECTS was higher, collateral status and reperfusion quality were better and time to treatment was shorter. Good outcome was seen in 239/316 (75.6%) with vs. 374/704 (53.1%) without predominantly deep grey matter infarcts. After adjusting for baseline variables and total infarct volume, predominantly deep grey matter infarcts were independently associated with excellent outcome (adjOR: 1.45 [CI95: 1.04-2.02]), but not with good outcome (adjOR: 1.24 [CI95: 0.86-1.80]) or mortality (adjOR: 0.73 [CI95:0.39-1.35]) CONCLUSION: Predominantly deep grey matter infarct patterns were seen in 1/3rd of patients and were significantly associated with increased chances of excellent outcome, independent of patient baseline status and infarct size.
PURPOSE: There are few data on the prevalence and impact of isolated deep grey matter infarction in acute stroke. In this study, we aimed to investigate the prevalence of isolated deep grey matter infarcts and their impact on the outcome. METHODS:Infarcts on 24-h follow-up imaging (non-contrast head CT or diffusion-weighted MRI) in the ESCAPE-NA1 trial were categorized into predominantly deep grey matter infarcts vs. infarcts involving additional territories ("other infarcts"). Total infarct volume was manually segmented. Baseline characteristics and proportions of good outcome (primary outcome, defined as modified Rankin Score [mRS] 0-2 at 90 days), excellent outcome (mRS 0-1) and mortality were compared between patients with and without predominantly deep grey matter infarcts. Multivariable logistic regression with adjustment for baseline variables and total infarct volume was used to determine a possible association of predominantly deep grey matter infarcts and clinical outcome. RESULTS: Predominantly deep grey matter infarcts were seen in 316/1026 patients (30.8%). Compared to other patients, their ASPECTS was higher, collateral status and reperfusion quality were better and time to treatment was shorter. Good outcome was seen in 239/316 (75.6%) with vs. 374/704 (53.1%) without predominantly deep grey matter infarcts. After adjusting for baseline variables and total infarct volume, predominantly deep grey matter infarcts were independently associated with excellent outcome (adjOR: 1.45 [CI95: 1.04-2.02]), but not with good outcome (adjOR: 1.24 [CI95: 0.86-1.80]) or mortality (adjOR: 0.73 [CI95:0.39-1.35]) CONCLUSION: Predominantly deep grey matter infarct patterns were seen in 1/3rd of patients and were significantly associated with increased chances of excellent outcome, independent of patient baseline status and infarct size.
Authors: Gabriel Gold; Enikö Kövari; François R Herrmann; Alessandra Canuto; Patrick R Hof; Jean-Pierre Michel; Constantin Bouras; Panteleimon Giannakopoulos Journal: Stroke Date: 2005-05-12 Impact factor: 7.914