Long-Term Functionality Prediction for First Time Ischemic Middle Cerebral Artery Stroke Patients Receiving Conventional Medical Treatment

Ju-Lan Yang; Chih-Ming Lin; Ying-Lin Hsu

doi:10.2147/NDT.S350266

Long-Term Functionality Prediction for First Time Ischemic Middle Cerebral Artery Stroke Patients Receiving Conventional Medical Treatment

Neuropsychiatr Dis Treat. 2022 Feb 17:18:275-288. doi: 10.2147/NDT.S350266. eCollection 2022.

Authors

Ju-Lan Yang^{1

2}, Chih-Ming Lin^{3

4

5}, Ying-Lin Hsu^{1

6}

Affiliations

¹ Department of Applied Mathematics, National Chung Hsing University, Taichung, Taiwan.
² Department of Rehabilitation Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
³ Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua City, Taiwan.
⁴ Department of Neurology, Changhua Christian Hospital, Changhua City, Taiwan.
⁵ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁶ Institute of Statistics, National Chung Hsing University, Taichung, Taiwan.

Abstract

Background: Middle cerebral artery (MCA) ischemic stroke poses a major threat to human beings and prompts intravenous thrombolytic and/or thrombectomy management remains the gold standard treatment. However, not all MCA stroke patients fit in the inclusion and exclusion criteria that many patients only receive conventional medical therapy. We attempt to seek the baseline parameters that can effectively predict patients' long-term functionality, as well as hypothesizing that the carotid duplex derived resistance/pulsatility index might be capable of fulfilling this purpose.

Methods: The 741 MCA ischemic stroke patients have been retrospectively recruited for the project. Under the initial screening, matching the inclusion and exclusion criteria, there are 471 participants to be enrolled in the study. The patients' basic information, along with outcome assessments, pre-admission Barthel index and NIHSS score, and pre- and post-treatment mRS are recorded. All statistical analyses were performed using R for Windows (version 3.6.3). The significance level was set at P < 0.05 for all analyses.

Results: Of the 471 patients, 239 participants show a net mRS improvement, whereas the other 232 show deterioration. Hyperlipidaemia, chronic kidney disease, and dementia are related to long-term functionality improvement. The multivariate logistic regression analysis shows that right common carotid artery (CCA) resistance index (RI) and ischemic heart disease play a significant role in favourable outcome functionality. The ROC and Youden Index models are formulated, and it shows that Barthel Index and the NIHSS are most significant in the outcome measurement group (AUC: 0.675, 0.653; cut-off point: 57.5, 3.5, respectively). The right-side CCA RI is the solely important outcome predictor for the baseline carotid duplex study (AUC: 0.5; cut-off point: 0.785).

Conclusion: The favourable long-term functionality of MCA ischemic stroke patients receiving conventional medical treatment seems to correlate fairly with pre-admission NIHSS and Barthel index scores. Underlying hyperlipidaemia, chronic kidney disease, and dementia are conversely associated with favourable long-term capability. Moreover, the value of CCA RI appears to significantly alter the long-term outcomes in this group of patients.

Keywords: Barthel Index; NIHSS; common carotid artery; ischemic stroke; mRS; middle cerebral artery; resistance index; thrombectomy; thrombolytic therapy.

Grants and funding

No funding was secured for this study.