acute treatment; magnetic resonance imaging; prognosis; Aged; Aged, 80 and over; Brain Infarction/complications; Brain Infarction/diagnostic imaging; Brain Infarction/pathology; Cohort Studies; Diffusion Magnetic Resonance Imaging; Female; Humans; Logistic Models; Male; Middle Aged; Recovery of Function; Stroke/diagnostic imaging; Stroke/pathology; Stroke/therapy; Thrombolytic Therapy; Treatment Outcome; Endovascular Procedures; Brain Infarction; Stroke; Surgery; Neurology (clinical); Psychiatry and Mental Health
Abstract :
[en] [en] 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.
Disciplines :
Neurology
Author, co-author :
Rosso, Charlotte; Inserm U 1127, CNRS UMR7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France charlotte.rosso@gmail.com ; APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
Blanc, Raphael; Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
Ly, Julien ; Centre Hospitalier Universitaire de Liège - CHU > > Service de neurologie ; Inserm U 1127, CNRS UMR7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France ; APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
Samson, Yves; Inserm U 1127, CNRS UMR7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France ; APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
Lehéricy, Stéphane; Inserm U 1127, CNRS UMR7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France ; APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, Paris, France
Gory, Benjamin; Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
Marnat, Gautier; Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
Mazighi, Mikael; Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
Consoli, Arturo; Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
Labreuche, Julien; Department of Biostatistics, University Lille, CHU Lille, Lille, France
Saleme, Suzana; Department of Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
Costalat, Vincent; Department of Diagnostic and Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
Bracard, Serge; Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
Desal, Hubert; Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
Piotin, Michel; Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
Lapergue, Bertrand; Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
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