Letter by Alves et al Regarding Article, “Effect of Right Insular Involvement on Death and Functional Outcome After Acute Ischemic Stroke in the IST-3 Trial (Third International Stroke Trial)”
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To the Editor:
In an interesting subanalysis of the important IST-3 (Third International Stroke Trial),1 the authors studied the impact of insular cortex infarct, visualized in follow-up scans, on functional outcome and death at 6 months. In this analysis, only patients with documented ischemic lesions in follow-up scans were included. Patients with insular involvement more frequently had admission National Institutes of Health Stroke Scale (NIHSS) score of ≥15 (59.3% versus 25.0%) and atrial fibrillation (35.3% versus 28.1%), and there was a marginal statistical difference concerning treatment allocation, with more patients with insular involvement having received alteplase (52.0% versus 47.4%). Unadjusted death at 6 months was strikingly higher for patients with right or left insular involvement; however, this association persisted only for right insular infarct after adjustment for …