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Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion

BACKGROUND: Although it is generally thought that patients with distal middle cerebral artery (M2) occlusion have a favorable outcome, it has previously been demonstrated that a substantial minority will have a poor outcome by 90 days. We sought to determine whether assessing the Alberta Stroke Prog...

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Autores principales: Khan, Muhib, Baird, Grayson L., Goddeau, Richard P., Silver, Brian, Henninger, Nils
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348492/
https://www.ncbi.nlm.nih.gov/pubmed/28352248
http://dx.doi.org/10.3389/fneur.2017.00098
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author Khan, Muhib
Baird, Grayson L.
Goddeau, Richard P.
Silver, Brian
Henninger, Nils
author_facet Khan, Muhib
Baird, Grayson L.
Goddeau, Richard P.
Silver, Brian
Henninger, Nils
author_sort Khan, Muhib
collection PubMed
description BACKGROUND: Although it is generally thought that patients with distal middle cerebral artery (M2) occlusion have a favorable outcome, it has previously been demonstrated that a substantial minority will have a poor outcome by 90 days. We sought to determine whether assessing the Alberta Stroke Program Early CT Score (ASPECTS) infarct location allows for identifying patients at risk for a poor 90-day outcome. METHODS: We retrospectively analyzed patients with isolated acute M2 occlusion admitted to a single academic center between January 2010 and August 2012. Infarct regions were defined according to ASPECTS system on the initial head computed tomography. Discriminant function analysis was used to define specific ASPECTS regions that are predictive of the 90-day functional outcome as defined as a modified Rankin Scale score of 3–6. In addition, logistic regression was used to model the relationship between each individual ASPECT region with poor outcome; for evaluation and comparison, odds ratios, c-statistics, and Akaike information criterion values were estimated for each region. RESULTS: Ninety patients with isolated M2 were included in the final analysis. ASPECTS score ≤6 predicted poor outcome in this cohort (sensitivity = 0.591, specificity = 0.838, p < 0.001). Using multiple approaches, we found that infarction in ASPECTS regions M3 and M6 were strongly associated with poor functional status by 90 days. CONCLUSION: Infarction in ASPECTS regions M3 and M6 are key predictors of functional outcome following isolated distal M2 occlusion. These findings will be helpful in stratifying outcomes if validated in future studies.
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spelling pubmed-53484922017-03-28 Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion Khan, Muhib Baird, Grayson L. Goddeau, Richard P. Silver, Brian Henninger, Nils Front Neurol Neuroscience BACKGROUND: Although it is generally thought that patients with distal middle cerebral artery (M2) occlusion have a favorable outcome, it has previously been demonstrated that a substantial minority will have a poor outcome by 90 days. We sought to determine whether assessing the Alberta Stroke Program Early CT Score (ASPECTS) infarct location allows for identifying patients at risk for a poor 90-day outcome. METHODS: We retrospectively analyzed patients with isolated acute M2 occlusion admitted to a single academic center between January 2010 and August 2012. Infarct regions were defined according to ASPECTS system on the initial head computed tomography. Discriminant function analysis was used to define specific ASPECTS regions that are predictive of the 90-day functional outcome as defined as a modified Rankin Scale score of 3–6. In addition, logistic regression was used to model the relationship between each individual ASPECT region with poor outcome; for evaluation and comparison, odds ratios, c-statistics, and Akaike information criterion values were estimated for each region. RESULTS: Ninety patients with isolated M2 were included in the final analysis. ASPECTS score ≤6 predicted poor outcome in this cohort (sensitivity = 0.591, specificity = 0.838, p < 0.001). Using multiple approaches, we found that infarction in ASPECTS regions M3 and M6 were strongly associated with poor functional status by 90 days. CONCLUSION: Infarction in ASPECTS regions M3 and M6 are key predictors of functional outcome following isolated distal M2 occlusion. These findings will be helpful in stratifying outcomes if validated in future studies. Frontiers Media S.A. 2017-03-14 /pmc/articles/PMC5348492/ /pubmed/28352248 http://dx.doi.org/10.3389/fneur.2017.00098 Text en Copyright © 2017 Khan, Baird, Goddeau, Silver and Henninger. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Khan, Muhib
Baird, Grayson L.
Goddeau, Richard P.
Silver, Brian
Henninger, Nils
Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion
title Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion
title_full Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion
title_fullStr Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion
title_full_unstemmed Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion
title_short Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion
title_sort alberta stroke program early ct score infarct location predicts outcome following m2 occlusion
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348492/
https://www.ncbi.nlm.nih.gov/pubmed/28352248
http://dx.doi.org/10.3389/fneur.2017.00098
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