Just why the hell are we using the Rankin scale for measuring anything in stroke? It has no discriminatory power and nothing objective except for 6 - death.
Originally published7 Dec 2018Stroke. 2018;0:STROKEAHA.118.023084
Abstract
Background and Purpose—
We
analyzed the association between cerebral microbleeds (CMBs) and
clinical outcome in acute ischemic stroke patients and especially in a
subgroup of patients with successful recanalization.(Your definition of success is obviously not what it should be. 100% recovery, not the lazy, 'Hey we got the artery open')
Methods—
A
total of 1532 acute ischemic stroke patients treated with intravenous
thrombolysis or mechanical thrombectomy were enrolled in this
prospective cohort study. The primary outcome was measured using the
modified Rankin Scale at 3 months, according to the CMB status based on
magnetic resonance imaging at admission. Favorable outcome was defined
as functional independence with modified Rankin Scale scores of 0 to 2.
Secondary outcomes included the occurrence of symptomatic intracranial
hemorrhage.
Results—
There
was no statistically significant association between the presence of
CMB and favorable outcome at 3 months when considering all patients
(44.3% versus 37.6%; P=0.121). In patients with recanalization,
the number of patients with favorable outcomes was significantly higher
in the CMB-negative than in the CMB-positive group (57.0% versus 36.0%; P<0.001).
In the final multivariate analysis, the presence of CMB, and in
particular high CMB burden (≥5), and lobar location, were significantly
associated with less favorable 3-month outcomes (odds ratio=0.57; 95%
CI, 0.33−0.97; P=0.038) and symptomatic intracranial hemorrhage (odds ratio=3.21; 95% CI, 1.37−7.49; P=0.007)
in patients with recanalization. In the analysis of subgroups, a
statistically significant interaction was found between CMB presence and
recanalization in predicting functional outcomes at 3 months.
Conclusions—
These
results indicate that the presence of CMBs, and especially high burden
and lobar location, are independent predictors of poor 3-month clinical
outcomes and may increase symptomatic intracranial hemorrhage risk in
acute ischemic stroke patients with recanalization. Our findings suggest
that CMBs lead to more unfavorable effects in patients with
recanalization after large vessel occlusion than in those without
recanalization.
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