Similar admission NIHSS may represent larger tissue-at-risk in patients with right-sided versus left-sided large vessel occlusion
Year: 2021
Type: article
Study design: Observational Study
Abstract: BACKGROUND: We investigated the effects of the side of large vessel occlusion (LVO) on post-thrombectomy infarct volume and clinical outcome with regard to admission National Institutes of Health Stroke Scale (NIHSS) score. METHODS: We retrospectively identified patients with anterior LVO who received endovascular thrombectomy and follow-up MRI. Applying voxel-wise general linear models and multivariate analysis, we assessed the effects of occlusion side, admission NIHSS, and post-thrombectomy reperfusion (modified Thrombolysis in Cerebral Infarction, mTICI) on final infarct distribution and volume as well as discharge modified Rankin Scale (mRS) score. RESULTS: We included 469 patients, 254 with left-sided and 215 with right-sided LVO. Admission NIHSS was higher in those with left-sided LVO (median (IQR) 16 (10-22)) than in those with right-sided LVO (14 (8-16), p>0.001). In voxel-wise analysis, worse post-thrombectomy reperfusion, lower admission NIHSS score, and poor discharge outcome were associated with right-hemispheric infarct lesions. In multivariate analysis, right-sided LVO was an independent predictor of larger final infarct volume (p=0.003). There was a significant three-way interaction between admission stroke severity (based on NIHSS), LVO side, and mTICI with regard to final infarct volume (p=0.041). Specifically, in patients with moderate stroke (NIHSS 6-15), incomplete reperfusion (mTICI 0-2b) was associated with larger final infarct volume (p<0.001) and worse discharge outcome (p=0.02) in right-sided compared with left-sided LVO. CONCLUSIONS: When adjusted for admission NIHSS, worse post-thrombectomy reperfusion is associated with larger infarct volume and worse discharge outcome in right-sided versus left-sided LVO. This may represent larger tissue-at-risk in patients with right-sided LVO when applying admission NIHSS as a clinical biomarker for penumbra.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Doris Duke Charitable Foundation, American Heart Association, Novartis, Biogen, European Commission, Bundesministerium für Bildung und Forschung, National Institutes of Health, Foundation of the American Society of Neuroradiology, National Institute on Aging, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Neurological Disorders and Stroke, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Hyperfine
Awards: Personalised Medicine by Predictive Modeling in Stroke for better Quality of Life, G1443945989, Comparative Effectiveness of Imaging Strategies in Acute Ischemic Stroke Based on Patient Profiles - Resubmission - 1, Big Data Neuroimaging to Predict Motor Behavior After Stroke, G2600604402, G3663848375, G4037081869, G4059395479, Precision blood pressure management after endovascular stroke therapy based on real-time autoregulation measurements, G5207379706, The Recovery in Stroke Using PAP (RISE UP) Study, Portable Magnetic Resonance Imaging for Cerebral Ischemia, Yale Clinical Site: Investigations For Improved Neurological Treatments at Yale (INFINITY), Dynamic Neuroimmune Profiling in Patients with Acute Intracerebral Hemorrhage, G9000038524, G9000084859, G9000210719, G9000281784, Anti-NMDA Receptor Antibodies in Adult Brain Dysfunction: Lessons from Lupus
OpenAlex ID: W3205677579