Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management.
Details
Serval ID
serval:BIB_2146206BAD3E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management.
Journal
International journal of stroke
ISSN
1747-4949 (Electronic)
ISSN-L
1747-4930
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Publication Status: aheadofprint
Abstract
The clinical evolution of acute ischemic stroke patients with isolated proximal posterior cerebral artery (PCA) occlusion treated with medical management alone has been poorly described. We aimed to determine the clinical and radiological factors associated with poor functional outcome in this population.
We conducted a multicenter international retrospective study of consecutive stroke patients with isolated occlusion of the first (P1) or second (P2) segment of PCA admitted within 6hrs from symptoms onset in 26 stroke centers in France, Switzerland and the USA, treated with best medical management alone. Poor functional outcome was defined as a modified Rankin scale (mRS) ≥2 at 3-month or no return to pre-stroke mRS. The associations between pretreatment variables and poor outcome were studied in univariable then multivariable analyses, as well as the association between poor outcome and key follow-up radiological variables.
Overall, 585 patients were included. Median age was 74 years (IQR, 63-83), median NIHSS was 6 (3-10), 80% received intravenous thrombolysis (IVT), 22% and 78% had P1 and P2 occlusion, respectively. Poor outcome occurred in 56% of patients. In multivariable analysis focusing on pretreatment variables, age (adjusted OR=1.12 per 5-year increase [95%CI 1.05-1.20]; P=0.001), NIHSS score (aOR=1.12 per each point increase [1.08-1.18]; P<0.001), infarct volume (aOR=1.16 per 5mL increase [1.07-1.25]; P<0.001), and the lack of IVT use (aOR=1.79 [1.10-2.94], P=0.020) were independently associated with poor outcome. Regarding 24-hr follow-up radiological variables, complete recanalization (defined as no clot in the vascular tree at or beyond the primary occlusive lesion, aOR=0.37 95%CI 0.21-0.65, P<0.001) and parenchymal hematoma occurence (aOR=2.37 95%CI 1.01-5.56, P=0.048) were independently associated with poor 3-month outcome.
Poor outcome occurred in more than half of medically treated PCA-related acute stroke patients. Facilitating IVT use may improve functional outcome. Therapeutic approaches aimed at enhancing recanalization and reducing hemorrhagic transformation need to be studied in clinical trials.
We conducted a multicenter international retrospective study of consecutive stroke patients with isolated occlusion of the first (P1) or second (P2) segment of PCA admitted within 6hrs from symptoms onset in 26 stroke centers in France, Switzerland and the USA, treated with best medical management alone. Poor functional outcome was defined as a modified Rankin scale (mRS) ≥2 at 3-month or no return to pre-stroke mRS. The associations between pretreatment variables and poor outcome were studied in univariable then multivariable analyses, as well as the association between poor outcome and key follow-up radiological variables.
Overall, 585 patients were included. Median age was 74 years (IQR, 63-83), median NIHSS was 6 (3-10), 80% received intravenous thrombolysis (IVT), 22% and 78% had P1 and P2 occlusion, respectively. Poor outcome occurred in 56% of patients. In multivariable analysis focusing on pretreatment variables, age (adjusted OR=1.12 per 5-year increase [95%CI 1.05-1.20]; P=0.001), NIHSS score (aOR=1.12 per each point increase [1.08-1.18]; P<0.001), infarct volume (aOR=1.16 per 5mL increase [1.07-1.25]; P<0.001), and the lack of IVT use (aOR=1.79 [1.10-2.94], P=0.020) were independently associated with poor outcome. Regarding 24-hr follow-up radiological variables, complete recanalization (defined as no clot in the vascular tree at or beyond the primary occlusive lesion, aOR=0.37 95%CI 0.21-0.65, P<0.001) and parenchymal hematoma occurence (aOR=2.37 95%CI 1.01-5.56, P=0.048) were independently associated with poor 3-month outcome.
Poor outcome occurred in more than half of medically treated PCA-related acute stroke patients. Facilitating IVT use may improve functional outcome. Therapeutic approaches aimed at enhancing recanalization and reducing hemorrhagic transformation need to be studied in clinical trials.
Keywords
Acute stroke therapy, Cerebral Infarction, Medical treatment, Posterior cerebral artery, Prognosis, Thrombolysis
Pubmed
Create date
16/12/2024 16:49
Last modification date
17/12/2024 7:09