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https://hdl.handle.net/2440/120809
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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 1526-632X |
Statement of Responsibility: | 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 Prognosis Aged Aged, 80 and over Middle Aged Female Male Stroke Perfusion Imaging Computed Tomography Angiography |
Rights: | © 2019 American Academy of Neurology |
DOI: | 10.1212/WNL.0000000000007553 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1013719 http://purl.org/au-research/grants/nhmrc/1043913 http://purl.org/au-research/grants/nhmrc/1110629 |
Published version: | http://dx.doi.org/10.1212/wnl.0000000000007553 |
Appears in Collections: | Aurora harvest 8 Medicine publications |
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