Abstract WP140: Concurrent Anterior Cerebral Artery Involvement Is Predictive of Mortality In Severe Middle Cerebral Artery Ischemic Stroke
Background: Severe middle cerebral artery (MCA) stroke is associated with a high rate of morbidity and mortality. We assessed the hypothesis that patient specific variables may be associated with outcomes. We also sought to describe under-recognized outcomes.
Methods: A consecutive, multi-institution, retrospective cohort of adult patients (≤70 years) was established from 2009-2011. 127 patients were first identified by NIHSS score ≥ 15 and then screened for initial infarct volume ≥ 60 mL3. Malignant edema was defined as the development of midline brain shift of ≥ 5 mm in the first 5 days. The only exclusion criterion was enrollment in any experimental trial. 6 patients were censored from secondary analysis given that therapeutic treatment was not pursued. A univariate and multivariate logistic regression analysis was performed to model and predict the factors related to outcomes. Significance was predefined at p≤0.05 (two-tailed).
Results: 46 patients (29 female, 17 male; mean age 57.3±1.5) met study criteria. The mortality rate was 28% (n=13). Univariate predictors of mortality included infarct volume, intracranial pressure (ICP) crisis, and concurrent anterior cerebral artery (ACA) involvement. In a multivariate analysis, only concurrent ACA involvement was associated with mortality (OR 9.78, 95% CI 1.15, 82.8, p=0.04). Univariate predictors of tracheostomy were decompressive craniectomy (DC) and admission GCS score. In multivariate analysis, only admission GCS score was significant (OR 0.59, 95% CI 0.37, 0.94, p=0.03). Infarct volume, elevated peak serum sodium level, hyperosmolar therapy, and ICP crisis independently predicted the development of malignant edema, whereas only infarct volume remained significant in multivariate analysis (OR 1.02, 95% CI 1.00, 1.04, p=0.05). In the malignant edema subgroup (n=23, 58%), 4 died (17%), 7 underwent DC (30%), 7 underwent tracheostomy (30%), and 15 underwent gastrostomy (65%).
Conclusion: Adverse outcomes after severe stroke are common. ACA involvement predicts mortality in severe MCA stroke. Knowledge of outcomes and their predictors is necessary for optimal care and future study.
- © 2012 by American Heart Association, Inc.