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Type: Journal article
Title: Influence of occlusion site and baseline ischemic core on outcome in patients with ischemic stroke
Author: Tian, H.
Parsons, M.W.
Levi, C.R.
Lin, L.
Aviv, R.I.
Spratt, N.J.
Butcher, K.S.
Lou, M.
Kleinig, T.J.
Bivard, A.
Citation: Neurology, 2019; 92(23):e2626-e2643
Publisher: Wolters Kluwer; American Academy of Neurology
Issue Date: 2019
ISSN: 0028-3878
Statement of
Huiqiao Tian, Mark W. Parsons, Christopher R. Levi, Longting Lin, Richard I. Aviv, Neil J. Spratt, Kenneth S. Butcher, Min Lou, Timothy J. Kleinig, and Andrew Bivard
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.
Keywords: Humans
Brain Ischemia
Infarction, Anterior Cerebral Artery
Infarction, Middle Cerebral Artery
Infarction, Posterior Cerebral Artery
Tissue Plasminogen Activator
Fibrinolytic Agents
Tomography, X-Ray Computed
Aged, 80 and over
Middle Aged
Perfusion Imaging
Computed Tomography Angiography
Rights: © 2019 American Academy of Neurology
DOI: 10.1212/WNL.0000000000007553
Grant ID:
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