Abstract W P33: Long-term Survival and Outcome Anticipation Based on Simple Grading of MR Perfusion in Severe Stroke Patients Due to the Carotid-Middle Cerebral Artery Occlusion
Introduction: It is difficult to anticipate long-term survival rate (SR) in an acute stroke stage. The aim of our study was to investigate whether or not simple probable CBF grading of MR perfusion was useful for anticipating long-term SR in severe acute stroke patients due to the carotid-middle cerebral artery occlusion.
Methods: Included were patients 1) who were admitted to our institution within 24 hours of onset between Jan 2005 and May 2014, 2) who underwent MRA displaying neither the internal carotid artery (ICA) nor the middle cerebral artery (MCA) in the affected side and 3) who were treated without any reperfusion therapy. We evaluated CBF grades, any death within 120 days and clinical outcome at 90 days. CBF grade was calculated by using bilateral time-intensity curves (TICs) of MR perfusion. TICs were generated on region of interests set at symmetrical positions of the bilateral MCA territories. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we regarded the affected-sided PSa divided by TPa as possible CBFa and the contralateral-sided PSc divided by TPc as possible CBFc. CBF grade 1 was defined as CBFa divided by CBFc (CBF%) less than 0.2, grade 2 as CBF% of 0.2 or more and CBF% less than 0.5 and grade 3 as CBF% of 0.5 or more.
Results: Sixty-three patients were analyzed. There were 25, 25 and 13 in grade 1, 2 and 3. Thirty-five patients (55.6%) died within 120 days, most of them (28 patients, 44.4%) died within 10 days. In grade 1, 2 and 3, 20, 12 and 3 patients died within 120 days, and SR of the Kaplan-Meier method at 120 days was 20%, 50.4% and 76.2% (p<0.001), respectively.
In grade 1, there were 0 patient in mRS of 0-2, 1 in mRS of 3-4 and 24 in mRS of 5-6 at 90 days, in grade 2, there were 0 in mRS of 0-2, 7 in mRS of 3-4 and 18 in mRS of 5-6, in grade 3, there were 1 in mRS of 0-2, 8 in mRS of 3-4 and 4 in mRS of 5-6 (p<0.001).
Conclusion: Simple grading of MR perfusion was useful for anticipating long-term survival rate and clinical outcome in acute stroke stage. We can realize that patients with grade 1 must be rescued and clinical outcome of patients with grade 2 or 3 must be improved
Author Disclosures: T. Mori: None. T. Iwata: None. Y. Tanno: None. S. Kasakura: None. Y. Aoyagi: None. K. Yoshioka: None.
- © 2015 by American Heart Association, Inc.