Abstract W P39: Relationship Between Lesion Topology and Clinical Outcome In Anterior Circulation Large Vessel Occlusions
Background: Final infarct volume is a robust predictor of outcome in large vessel occlusion (LVO) patients but lesion location may also impact outcomes in these patients. DWI ASPECTS on follow-up MRI imaging, like infarct volume, is predictive of outcome in addition to providing information regarding lesion location. We aim to determine whether individual DWI ASPECTS regions have an impact on clinical outcome in anterior circulation large vessel occlusions.
Methods: Patients with intracranial ICA, M1 and M2 MCA occlusions who underwent endovascular therapy between 2007 and 2014 at UPMC were included. Baseline demographics and outcomes including final infarct volume and 3-month mRS were collected. DWI ASPECTS based on follow-up MRI (12-72 hrs) was assessed by two observers. The impact of each DWI ASPECTS region on predicting poor outcome (mRS 3-6) was assessed by logistic regression analysis.
Results: 213 patients were included in the analysis (mean age 66.1±1.0 yrs, median NIHSS 15 [IQR 11-18], 19.5% ICA and 72% M1 MCA occlusions, 3-month mRS 3-6 of 46.8%). Inter-rater reliability was good for DWI ASPECTS (Deep ASPECTS regions: Kappa=0.72, Cortical ASPECTS regions: Kappa=0.63). All DWI ASPECTS regions with the exception of “putamen” were significant predictors (p<0.05) of poor outcome in univariate analysis. In a multivariate analysis with all 10 ASPECTS regions included, only M4 (OR=0.33 95%CI 0.16-0.70, p=0.003) and M6 (OR 0.39, 95%CI 0.18-0.85, p=0.018) significantly predicted poor outcome while deep regions (caudate, putamen and internal capsule) did not. After controlling for final infarct volume, M4 (p=0.045) and M6 (p=0.018) regions remained significant predictors of poor outcome. M6 was independently associated with poor outcome in right hemispheric lesions (OR 0.13 95%CI 0.04-0.47, p=0.002) while M4 (OR 0.14 95%CI 0.04-0.48, p=0.011) predicted poor outcome in left hemispheric lesions.
Conclusions: Involvement of the right parieto-occipital (M6) and left superior-frontal (M4) regions seem to have a significant impact on outcome in LVO patients. While these results need to be replicated in other patient cohorts, lesion topology may also need to be considered in outcome prediction in LVO patients.
Author Disclosures: S. Rangaraju: None. C. Streib: None. A. Jadhav: None. T.G. Jovin: Consultant/Advisory Board; Modest; Dr Jovin: Consulting and speaker fees from Co-Axia, ev3, Concentric Medical and Micrus..
- © 2015 by American Heart Association, Inc.