Abstract WMP47: Burden of Intracranial Steno-occlusive Lesions on Initial CT Angiography is Predictive of Poor Outcomes in Patients with Stroke And TIA
Background: CT-angiography (CTA) is an accurate non-invasive method to diagnose intracranial steno-occlusive disease (ICAD) at initial presentation for stroke. We aimed to identify CTA features associated with unfavorable outcome.
Methods: We identified patients with ICAD in the STOP-Stroke Study, a prospective imaging-based study of stroke outcomes in consecutive patients with ischemic stroke or transient ischemic attack (TIA) presenting to two academic medical centers. All patients underwent CTA which were graded by two neuroradiologists independently. Univariate and multiple logistic regression was used to evaluate predictors of favorable outcome at 6-months, defined as a modified Rankin Scale ≤2.
Results: Among 539 patients that met study entry criteria, ICAD was identified in 212 (39%); 116 (22%) had concurrent extra-intracranial lesions, and 66 (12%) had multiple sites of ICAD. Patients with ICAD had more severe stroke (median NIHSS 9 vs. 3, p<0.001), worse outcomes at 6-months (mRS 0-2, 57% vs. 73%, p<0.001), and higher mortality (18% vs. 8%, p=0.001). In the multivariate model, age (OR 0.75 per decade, 95% CI 0.65-0.87), female sex (OR 0.49, 95% CI 0.32-0.73), multiple sites of ICAD (OR 0.53, 95% CI 0.29-0.97), complete occlusion (OR 0.42, 95% CI 0.25-0.72), and concurrent extra-intracranial lesions (OR 0.51, 95% CI 0.31-0.84) negatively predicted favorable outcome.
Conclusion: CTA findings of multiple sites of ICAD, concurrent extra-intracranial lesions, and complete occlusion are independent predictors of unfavorable outcome at 6-months.
- © 2012 by American Heart Association, Inc.