You mean we might finally get infarct location mapped to functional disability? And that could mean objective damage diagnosis rather than the subjective crapola of the Rankin scale. Progress might finally be made.
Impact of infarct location on functional outcome following endovascular therapy for stroke
Abstract
Objectives
The relationship between stroke topography (ie, the regions damaged by
the infarct) and functional outcome can aid clinicians in their
decision-making at the acute and later stages. However, the side (left
or right) of the stroke may also influence the identification of
clinically relevant regions. We sought to determine which brain regions
are associated with good functional outcome at 3 months in patients with
left-sided and right-sided stroke treated by endovascular treatment
using the diffusion-weighted imaging-Alberta Stroke Program Early CT
Score (DWI-ASPECTS).
Methods
Patients with ischaemic stroke (n = 405) were included from the ASTER
trial and Pitié-Salpêtrière registry. Blinded readers rated ASPECTS on
day 1 DWI. Stepwise logistic regression analyses were performed to
identify the regions related to 3-month outcome in left (n = 190) and
right (n = 215) sided strokes with the modified Rankin scale (0–2) as a
binary independent variable and with the 10 regions-of-interest of the
DWI-ASPECTS as independent variables.
Results
Median National Institute of Health Stroke Scale (NIHSS) at baseline
was 17 (IQR: 12–20), median age was 70 years (IQR: 58–80) and median
day-one NIHSS 9 (IQR: 4–18). Not all brain regions have the same weight
in predicting good outcome at 3 months; moreover, these regions depend
on the affected hemisphere. In left-sided strokes, the multivariate
analysis revealed that preservation of the caudate nucleus, the internal
capsule and the cortical M5 region were independent predictors of good
outcome. In right-sided strokes, the cortical M3 and M6 regions were
found to be clinically relevant.
Conclusion
Cortical non-motors areas related to outcome differed between
left-sided and right-sided strokes. This difference might reflect the
specialisation of the dominant and non-dominant hemispheres for language
and attention, respectively. These results may influence
decision-making at the acute and later stages.
Trial registration number
NCT02523261.
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