Impact of infarct location on functional outcome following endovascular therapy for stroke

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

1. Charlotte Rosso1,2,
2. Raphael Blanc3,
3. Julien Ly1,2,
4. Yves Samson1,2,
5. Stéphane Lehéricy1,4,
6. Benjamin Gory5,
7. Gautier Marnat6,
8. Mikael Mazighi3,
9. Arturo Consoli7,
10. Julien Labreuche8,
11. Suzana Saleme9,
12. Vincent Costalat10,
13. Serge Bracard5,
14. Hubert Desal11,
15. Michel Piotin3,
16. Bertrand Lapergue7
17. on behalf of the ASTER Trial and Pitié-Salpêtrière Investigators

Author affiliations

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.

http://dx.doi.org/10.1136/jnnp-2018-318869