Relationship Between Lesion Topology and Clinical Outcome in Anterior Circulation Large Vessel Occlusions

Srikant Rangaraju; Christopher Streib; Amin Aghaebrahim; Ashutosh Jadhav; Michael Frankel; Tudor G Jovin

doi:10.1161/STROKEAHA.115.009908

Relationship Between Lesion Topology and Clinical Outcome in Anterior Circulation Large Vessel Occlusions

Stroke. 2015 Jul;46(7):1787-92. doi: 10.1161/STROKEAHA.115.009908. Epub 2015 Jun 9.

Authors

Srikant Rangaraju¹, Christopher Streib¹, Amin Aghaebrahim¹, Ashutosh Jadhav¹, Michael Frankel¹, Tudor G Jovin²

Affiliations

¹ From the Emory University, Atlanta, GA (S.R., M.F.); and University of Pittsburgh Medical Center, PA (C.S., A.A., A.J., T.G.J.).
² From the Emory University, Atlanta, GA (S.R., M.F.); and University of Pittsburgh Medical Center, PA (C.S., A.A., A.J., T.G.J.). jovitg@upmc.edu.

Abstract

Background and purpose: Diffusion-weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS), a surrogate of infarct volume, predicts outcome in anterior large vessel occlusion strokes. We aim to determine whether topological information captured by DWI ASPECTS contributes additional prognostic value.

Methods: Adults with intracranial internal carotid artery, M1 or M2 middle carotid artery occlusions who underwent endovascular therapy were included. The primary outcome measure was poor clinical outcome (3-month modified Rankin Scale score, 3-6). Prognostic value of the 10 DWI ASPECTS regions in predicting poor outcome was determined by multivariable logistic regression, controlling for final infarct volume, age, and laterality.

Results: Two hundred and thirteen patients (mean age, 66.1±14.5 years; median National Institutes of Health Stroke Scale, 15) were included. Inter-rater reliability was good for DWI ASPECTS (deep regions, κ=0.72; cortical regions, κ=0.63). All DWI ASPECTS regions with the exception of the putamen were significant predictors (P<0.05) of poor outcome in univariate analyses. Statistical collinearity among ASPECTS regions was not observed. Using penalized multivariable logistic regression, only M4 (odds ratio, 2.82; 95% confidence interval, 1.39-5.76) and M6 (odds ratio, 2.45; 95% confidence interval, 1.15-5.3) involvement were associated with poor outcome. M6 involvement independently predicted poor outcome in right hemispheric strokes (odds ratio, 5.8; 95% confidence interval, 1.9-20.3), whereas M4 (odds ratio, 4.3; 95% confidence interval, 1.3-15.0) involvement predicted poor outcome in left hemispheric strokes adjusting for infarct volume. Topologic information modestly improved the predictive ability of a prognostic score that incorporates age, infarct volume, and hemorrhagic transformation.

Conclusions: Involvement of the right parieto-occipital (M6) and left superior frontal (M4) regions affect clinical outcome in anterior large vessel occlusions over and above the effect of infarct volume and should be considered during prognostication.

Keywords: anterior cerebral circulation infarction; diffusion magnetic resonance; outcome assessment (health care); stroke.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Carotid Artery Diseases / diagnosis*
Carotid Artery Diseases / drug therapy*
Carotid Artery Diseases / epidemiology
Cerebrovascular Circulation*
Cohort Studies
Diffusion Magnetic Resonance Imaging / methods
Female
Humans
Male
Middle Aged
Prospective Studies
Stroke / diagnosis*
Stroke / drug therapy*
Stroke / epidemiology
Thrombolytic Therapy* / methods
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding