Multimodal Predictors of Massive Ischemic Stroke & Favourable Outcome.

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University of Thessaly, Larissa, Greece

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Multimodal Predictors of Massive Ischemic Stroke & Favourable Outcome. Olivier Bill1, Philippe Zufferey1, Mohamed Faouzi2, Patrik Michel1, 1Neurology Service and 2Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland Unité cérébrovasculaire Acute STroke Registry & Analysis of Lausanne Table 1 : Acute phase predictors in the MVA. Table 2: Acute +Subacute phase predictors combined in the MVA. 4.Conclusions Massive stroke presentation is predicted by multiple clinical, radiological and metabolic variables, several of which are modifiable. Predictors in the 28% of patients with favourable outcome despite massive stroke include hypolipemic pretreatment, lower acute temperature, lower glucose levels at 24 hours and arterial recanalisation. 1. Background and Objective Severe stroke carries a high case fatality and disability rate. The aims of this study are to determine the characteristics of patients with initially severe (“massive”) ischemic stroke, and to identify acute and subacute predictors of favourable clinical outcome in such patients 2.Methods and Patients Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we compared all patients with massive stroke defined as a National Institute of Health Stroke Scale (NIHSS) ≥ 20 on admission with all the other patients. In a multivariate analysis, associations with demographic, clinical, pathophysiological, metabolic and neuroimaging factors and were determined. Furthermore, we analyzed predictors in the subgroup of massive stroke patients with favourable outcome (modified Rankin scale (mRS) ≤3 at three months). Factors OR 95% CI p-value Age 0.95 0.92 0.97 <0.01 Pre stroke handicap (mRs) 0.62 0.40 0.03 Private insurance status 2.51 1.05 5.98 0.037 Acute temperature 0.42 0.23 0.74 Acute glucose value 0.61 0.90 Acute endovascular treatment within recommended time limits (IVT or EVT) 2.47 1.20 5.08 0.01 Factors OR 95% CI p-value Age 0.94 0.91 0.97 <0.01 Previous cerebrovascular event (stroke, TIA, retinal ischemia) 3.00 1.00 8.96 0.04 Hypolipemic treatement at stroke onset 3.82 1.34 10.89 0.01 Acute temperature 0.42 0.23 0.78 Subacute glucose values at 24-48 hours 0.73 0.56 0.96 0.02 Recanalisation of cervical and/or intracranial arteries 4.51 1.95 10.4 5.References Robertson SC et all.Clinical course and surgical management of massive cerebral infarction. Neurosurgery 2004 July;55(1):55-61. Vahedi K et all. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007 March;6(3):215-22 Heinsius T et all. Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns. Neurology 1998 February;50(2):341-50. Hacke W et all. 'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 1996 April;53(4):309-15. 3. Results In the 68 (28%) patients with favourable outcome despite massive stroke, this was predicted by lower age (OR=0.94 / 95% CI 0.92 - 0.97), preceding cerebrovascular events (OR=3.00 / 95% CI 1.01 - 8.97), hypolipemic pre-treatement (OR= 3.82 / 95% CI 1.34 - 10.90), lower acute temperature (OR=0.43 / 95% CI 0.23 - 0.78), lower subacute glucose concentration (OR=0.74 / 95% CI 0.56 - 0.97), and spontaneous or treatment-induced recanalisation (OR= 4.51 / 95%CI 1.96 - 10.41).