Impact of infarct location on functional outcome following endovascular therapy for stroke
Charlotte Rosso, Raphael Blanc, Julien Ly, Yves Samson, Stéphane Lehéricy, Benjamin Gory, Gautier Marnat, Mikael Mazighi, Arturo Consoli, Julien Labreuche, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Michel Piotin, Bertrand Lapergue, ASTER Trial and Pitié-Salpêtrière Investigators, Michel Piotin, Raphael Blanc, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Mikael Mazighi, Robert Fahed, Jean-Philippe Desilles, Bertrand Lapergue, Georges Rodesch, Arturo Consoli, Oguzhan Coskun, Federico Di Maria, Frédéric Bourdain, Jean Pierre Decroix, Adrien Wang, Maya Tchikviladze, Serge Evrard, Francis Turjman, Benjamin Gory, Paul Emile Labeyrie, Roberto Riva, Charbel Mounayer, Suzanna Saleme, Vincent Costalat, Alain Bonafé, Omer Eker, Grégory Gascou, Cyril Dargazanli, Serge Bracard, Romain Tonnelet, Anne Laure Derelle, René Anxionnat, Hubert Desal, Romain Bourcier, B Daumas-Duport, Jérome Berge, Xavier Barreau, Gauthier Margnat, Lynda Djemmane, Julien Labreuche, Alain Duhamel, Yves Samson, Sophie Crozier, Sandrine Deltour, Anne Leger, Flore Baronnet, Charlotte Rosso, Fredéric Clarencon, Nader Sourour, Ehmad Shotar, Christine Pires, Charlotte Rosso, Raphael Blanc, Julien Ly, Yves Samson, Stéphane Lehéricy, Benjamin Gory, Gautier Marnat, Mikael Mazighi, Arturo Consoli, Julien Labreuche, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Michel Piotin, Bertrand Lapergue, ASTER Trial and Pitié-Salpêtrière Investigators, Michel Piotin, Raphael Blanc, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Mikael Mazighi, Robert Fahed, Jean-Philippe Desilles, Bertrand Lapergue, Georges Rodesch, Arturo Consoli, Oguzhan Coskun, Federico Di Maria, Frédéric Bourdain, Jean Pierre Decroix, Adrien Wang, Maya Tchikviladze, Serge Evrard, Francis Turjman, Benjamin Gory, Paul Emile Labeyrie, Roberto Riva, Charbel Mounayer, Suzanna Saleme, Vincent Costalat, Alain Bonafé, Omer Eker, Grégory Gascou, Cyril Dargazanli, Serge Bracard, Romain Tonnelet, Anne Laure Derelle, René Anxionnat, Hubert Desal, Romain Bourcier, B Daumas-Duport, Jérome Berge, Xavier Barreau, Gauthier Margnat, Lynda Djemmane, Julien Labreuche, Alain Duhamel, Yves Samson, Sophie Crozier, Sandrine Deltour, Anne Leger, Flore Baronnet, Charlotte Rosso, Fredéric Clarencon, Nader Sourour, Ehmad Shotar, Christine Pires
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.
Keywords: acute treatment; magnetic resonance imaging; prognosis.
Conflict of interest statement
Competing interests: None declared.
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Source: PubMed