Abstract
PurposeFollow-up infarct volume (FIV) is moderately associated with functional outcome. We hypothesized that accounting for infarct location would strengthen the association of FIV with functional outcome.MethodsWe included 252 patients from the HERMES collaboration with follow-up diffusion weighted imaging. Patients received endovascular treatment combined with best medical management (n = 52%) versus best medical management alone (n = 48%). FIV was quantified in low, moderate and high modified Rankin Scale (mRS)-relevant regions. We used binary logistic regression to study the relation between the total, high, moderate or low mRS-relevant FIVs and favorable outcome (mRS < 2) after 90 days. The strength of association was evaluated using the c-statistic.ResultsSmall lesions only occupied high mRS-relevant brain regions. Lesions additionally occupied lower mRS-relevant brain regions if FIV expanded. Higher FIV was associated with a higher risk of unfavorable outcome, as were volumes of tissue with low, moderate and high mRS relevance. In multivariable modeling, only the volume of high mRS-relevant infarct was significantly associated with favorable outcome. The c-statistic was highest (0.76) for the models that included high mRS-relevant FIV or the combination of high, moderate and low mRS-relevant FIV but was not significantly different from the model that included only total FIV (0.75).ConclusionThis study confirms the association of FIV and unfavorable functional outcome but showed no strengthened association if lesion location was taken into account.
Highlights
Despite advances in treatment of acute ischemic stroke (AIS), many patients do not return to functional independence
Follow-up infarct volume (FIV) is only moderately associated with outcome: only 12% of functional outcome is explained by FIV [1]
We aimed to study whether the association between FIV as depicted on FU Diffusion weighted imaging (DWI) and functional outcome according to the modified Rankin Scale (mRS) at 90 days is strengthened when lesion location is taken into account for patients with an anterior large vessel occlusion
Summary
Despite advances in treatment of acute ischemic stroke (AIS), many patients do not return to functional independence. Follow-up infarct volume (FIV) is associated with functional outcome after AIS and has been suggested as a prognostic marker. The association between the volume of infarcted tissue and functional outcome varies among lesion locations[2,3,4]. Neuroradiology lesion volume and functional outcome, measured by mRS at 90 days, is stronger if lesion location is taken into account. In the study of Ernst et al, an increase in lesion volume in high mRS-relevant areas was associated with a higher risk of unfavorable outcome. We aimed to study whether the association between FIV as depicted on FU DWI and functional outcome according to the mRS at 90 days is strengthened when lesion location is taken into account for patients with an anterior large vessel occlusion
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