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. 2022 Mar;64(3):521-530.
doi: 10.1007/s00234-021-02784-x. Epub 2021 Sep 3.

Value of infarct location in the prediction of functional outcome in patients with an anterior large vessel occlusion: results from the HERMES study

Manon L Tolhuisen  1   2 , Marielle Ernst  3 , Anne M M Boers  4 , Scott Brown  5 , Ludo F M Beenen  6 , Francis Guillemin  7 , Yvo B W E M Roos  8 , Jeffrey L Saver  9 , Robert van Oostenbrugge  10   11 , Andrew M Demchuck  12 , Wim van Zwam  13 , Tudor G Jovin  14 , Olvert A Berkhemer  6   15   16 , Keith W Muir  17 , Serge Bracard  7   18 , Bruce C V Campbell  19   20 , Aad van der Lugt  17 , Phill White  21   22 , Michael D Hill  12   23   24   25 , Diederik W J Dippel  15 , Peter J Mitchell  20 , Mayank Goyal  12 , Matthan W A Caan  26 , Henk A Marquering  26   6 , Charles B L M Majoie  6 ; HERMES collaborators
Affiliations

Value of infarct location in the prediction of functional outcome in patients with an anterior large vessel occlusion: results from the HERMES study

Manon L Tolhuisen et al. Neuroradiology. 2022 Mar.

Abstract

Purpose: Follow-up infarct volume (FIV) is moderately associated with functional outcome. We hypothesized that accounting for infarct location would strengthen the association of FIV with functional outcome.

Methods: We included 252 patients from the HERMES collaboration with follow-up diffusion weighted imaging. Patients received endovascular treatment combined with best medical management (n = 52%) versus best medical management alone (n = 48%). FIV was quantified in low, moderate and high modified Rankin Scale (mRS)-relevant regions. We used binary logistic regression to study the relation between the total, high, moderate or low mRS-relevant FIVs and favorable outcome (mRS < 2) after 90 days. The strength of association was evaluated using the c-statistic.

Results: Small lesions only occupied high mRS-relevant brain regions. Lesions additionally occupied lower mRS-relevant brain regions if FIV expanded. Higher FIV was associated with a higher risk of unfavorable outcome, as were volumes of tissue with low, moderate and high mRS relevance. In multivariable modeling, only the volume of high mRS-relevant infarct was significantly associated with favorable outcome. The c-statistic was highest (0.76) for the models that included high mRS-relevant FIV or the combination of high, moderate and low mRS-relevant FIV but was not significantly different from the model that included only total FIV (0.75).

Conclusion: This study confirms the association of FIV and unfavorable functional outcome but showed no strengthened association if lesion location was taken into account.

Keywords: Acute ischemic stroke; Diffusion weighted imaging; Follow-up infarct location; Functional outcome.

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Conflict of interest statement

The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Dr. Majoie reports grants from CVON/Dutch Heart Foundation, TWIN Foundation, European Commission, Dutch Health Evaluation program and Stryker outside the submitted work (paid to institution) and is shareholder of Nico.lab International Ltd. A.van der Lugt and D.W.J.Dippel are the recipients of unrestricted grants from Dutch Heart Foundation, Dutch Brain Foundation, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Science, Stryker, Medtronic, Penumbra Inc. and Cerenovus for the conduct of trials of acute treatment for stroke. Dr. Caan is shareholder of Nico.lab International Ltd. Dr. H.A. Marquering is co-founder and shareholder of Nico.lab International Ltd. Dr. Saver is an employee of the University of California. The University of California has patent rights in retrieval devices for stroke. The University of California Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled in multicenter clinical trials sponsored by Medtronic, Stryker, Cerenovus and Rapid Medical; Dr. Saver served as an unpaid site investigator under these contracts. Dr. Saver has received contracted hourly payments and travel reimbursement for services as a scientific consultant advising on rigorous trial design and conduct to Medtronic, Stryker and Cerenovus. Dr. Saver has received contracted stock options for services as a scientific consultant advising on rigorous trial design and conduct to Rapid Medical. Prof White declares institutional unrestricted educational grants from Medtronic, Penumbra and Stryker, institutional grant from Microvention and personal consultancy work for Microvention. Prof K Muir has received fees for advisory boards or speaking from Boehringer Ingelheim, Biogen, Bayer, Daiichi Sankyo and ReNeuron, and receives institutional support from Boehringer Ingelheim for the ATTEST-2 trial.

Figures

Fig. 1
Fig. 1
The division of brain regions according to high, moderate and low mRS relevance
Fig. 2
Fig. 2
An example of the infarct segmentations on diffusion weighted MRI in areas with different mRS relevance
Fig. 3
Fig. 3
Infarct distribution shown for the axial (a), coronal (b) and sagittal (c) slice with the largest infarct probability present
Fig. 4
Fig. 4
Box plots showing the infarct volume distribution per mRS category for the low (a), moderate (b) and high (c) mRS-relevant infarct regions and the total infarct volume (d)
Fig. 5
Fig. 5
Lesion volume distribution classified as low, moderate and high mRS relevant. Total lesion volume increases along the x-axis. Each bar represents a single subject
See this image and copyright information in PMC

References

    1. Boers AMM et al (2018) Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials. J Neurointerv Surg 10(12):1137–1142 - PubMed
    1. Ernst M, et al. Association of computed tomography ischemic lesion location with functional outcome in acute large vessel occlusion ischemic stroke. Stroke. 2017;48(9):2426–2433. doi: 10.1161/STROKEAHA.117.017513. - DOI - PubMed
    1. Cheng B, et al. Influence of stroke infarct location on functional outcome measured by the modified Rankin scale. Stroke. 2014;45(6):1695–1702. doi: 10.1161/STROKEAHA.114.005152. - DOI - PubMed
    1. Munsch F, et al. Stroke location is an independent predictor of cognitive outcome. Stroke. 2016;47(1):66–73. doi: 10.1161/STROKEAHA.115.011242. - DOI - PubMed
    1. Wu O, et al. Role of acute lesion topography in initial ischemic stroke severity and long-term functional outcomes. Stroke. 2015;46(9):2438–2444. doi: 10.1161/STROKEAHA.115.009643. - DOI - PMC - PubMed