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Abstract
Background and Objectives The best management of patients with mild stroke and large vessel occlusion (LVO) remains unclear. This study aimed to identify perfusion imaging predictors of poor functional outcome in such patients.
Methods This cohort study retrospectively selected patients enrolled in the International Stroke Perfusion Imaging Registry between August 2011 and April 2022. The registry enrolled patients with acute ischemic stroke and with baseline CT perfusion scanned within 24 hours of stroke onset. This study identified patients with mild symptoms, defined by an NIH Stroke Scale score of ≤5. Patients with LVO of anterior circulation were selected. This study further selected patients who received medical management and excluded patients who received endovascular treatment. The primary outcome was poor functional outcome defined as a modified Rankin Scale of 3–6 at 3 months. Perfusion lesion was defined by delay time > 3 seconds on CTP. Regression analyses were used to identify clinical and imaging variables that predicted poor functional outcome.
Results A total of 139 patients with mild stroke were included, of whom 27 (19%) had poor functional outcome. Patients with poor outcome, compared with those with good outcome, had much larger perfusion lesion volume (median 80 mL vs 41 mL, p < 0.001). Perfusion lesion was a significant predictor of poor outcome in either univariable regression (crude OR = 1.02, 95% CI = [1.01–1.03]) or multivariable regression model (adjusted OR = 1.01, 95% CI = [1.01–1.02]), adjusting for occlusion site, good collaterals, baseline stroke severity, age, IV thrombolysis (IVT), and onset to scan time. A perfusion lesion of 65 mL was the optimal cutpoint to identify poor functional outcome (sensitivity = 59%, specificity = 77%). Patients with perfusion lesion ≥65 mL, compared with patients with perfusion lesion <65 mL, showed a much higher rate of poor functional outcome (38% vs 11%, p < 0.001). Of the 139 patients in this study, 95 received IVT. Patients treated with or without IVT did not influence their outcomes (crude OR = 0.74, 95% CI = [0.31–1.78]).
Discussion A perfusion lesion of ≥65 mL predicted poor functional outcome in mild stroke patients with LVO.
Glossary
- ASPECTS=
- Alberta Stroke Program Early CT Score;
- CBF=
- cerebral blood flow;
- CTP=
- CT perfusion;
- DT=
- delay time;
- EVT=
- endovascular thrombectomy;
- INSPIRE=
- International Stroke Perfusion Imaging Registry;
- IVT=
- IV thrombolysis;
- LVO=
- large vessel occlusion;
- NCCT=
- noncontrast CT;
- NIHSS=
- NIH Stroke Scale;
- PH=
- parenchymal hemorrhage;
- sICH=
- symptomatic intracerebral hemorrhage
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work as first authors.
↵† These authors contributed equally to this work as senior authors.
Submitted and externally peer reviewed. The handling editor was José Merino, MD, MPhil, FAAN.
CME Course: NPub.org/cmelist
- Received February 20, 2022.
- Accepted in final form September 15, 2022.
- © 2022 American Academy of Neurology
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