Low Free Triiodothyronine Predicts 3-Month Poor Outcome After Acute Stroke

Background and Purpose

The association between thyroid hormone levels and long-term clinical outcome in patients with acute stroke has not yet been thoroughly studied. The purpose of the present study was to test the hypothesis that thyroid hormone levels are associated with 3-month functional outcome and mortality after acute stroke.

Does the Magnitude of the Electrocardiogram QT Interval Dispersion Predict Stroke Outcome?

Background

QT dispersion, maximal interlead difference in QT interval on 12-lead electrocardiogram (ECG), measures cardiac repolarization abnormalities. Data are conflicting whether QT dispersion predicts adverse outcome in acute ischemic stroke (AIS) patients. Our objective is to determine if QT dispersion predicts: (1) short-term clinical outcome in AIS, and (2) stroke location (insular versus noninsular cortex).

Early predictors of dysphagia in ischaemic stroke patients

Background and purpose

Post-stroke dysphagia affects outcome. In acute stroke patients, the aim was to evaluate clinical, cognitive and neuroimaging features associated with dysphagia and develop a predictive score for dysphagia.

Methods

Ischaemic stroke patients underwent clinical, cognitive and pre-morbid function evaluations. Dysphagia was retrospectively scored on admission and discharge with the Functional Oral Intake Scale.

Results

In all, 228 patients (mean age 75.8 years; 52% males) were included. On admission, 126 (55%) were dysphagic (Functional Oral Intake Scale ≤6). Age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05), pre-event modified Rankin scale (mRS) score (OR 1.41, 95% CI 1.09–1.84), National Institutes of Health Stroke Scale (NIHSS) score (OR 1.79, 95% CI 1.49–2.14), frontal operculum lesion (OR 8.53, 95% CI 3.82–19.06) and Oxfordshire total anterior circulation infarct (TACI) (OR 1.47, 95% CI 1.05–2.04) were independently associated with dysphagia at admission. Education (OR 0.91, 95% CI 0.85–0.98) had a protective role. At discharge, 82 patients (36%) were dysphagic. Pre-event mRS (OR 1.28, 95% CI 1.04–1.56), admission NIHSS (OR 1.88, 95% CI 1.56–2.26), frontal operculum involvement (OR 15.53, 95% CI 7.44–32.43) and Oxfordshire classification TACI (OR 3.82, 95% CI 1.95–7.50) were independently associated with dysphagia at discharge. Education (OR 0.89, 95% CI 0.83–0.96) and thrombolysis (OR 0.77, 95% CI 0.23–0.95) had a protective role. The 6-point “NOTTEM” (NIHSS, opercular lesion, TACI, thrombolysis, education, mRS) score predicted dysphagia at discharge with good accuracy. Cognitive scores had no role in dysphagia risk.

Conclusions

Dysphagia predictors were defined and a score was developed to evaluate dysphagia risk during stroke unit stay. In this setting, cognitive impairment is not a predictor of dysphagia. Early dysphagia assessment may help in planning future rehabilitative and nutrition strategies.     

High-Resolution Pulse Oximetry (HRPO): A Cost-Effective Tool in Screening for Obstructive Sleep Apnea (OSA) in Acute Stroke and Predicting Outcome

Introduction

Obstructive sleep apnea (OSA) is a well-known risk factor for stroke. This is attributed to multiple mechanisms such as endothelial dysfunction, atrial fibrillation, hypertension, and comorbid obesity. STOP questionnaire alone is unreliable to diagnose OSA and in-hospital sleep study is costly and can be technically challenging. We used high-resolution pulse oximetry (HRPO) to test the feasibility of screening for OSA and predicting outcome.

Impact of Treatment Time on the Long-Term Outcome of Stroke Patients Treated With Mechanical Thrombectomy

Objective

To assess the long-term functional outcome of stroke in patients treated with mechanical thrombectomy (MT) performed during work hours (on-hours) versus after-hours, weekends, and official holidays (off-hours).

Correlation of continuous electroencephalogram with clinical assessment scores in acute stroke patients

Objective To compare electroencephalogram (EEG) symmetry values between stroke patients with different 28-day outcomes, and to assess correlations between clinical characteristics and 28-day outcomes. Methods Twenty-two patients presenting with acute ischemic stroke and persistent neurological deficits at EEG recording were incrementally included. At 28 days after admission, the modified Rankin scale (mRS) was used to evaluate the outcomes, based on which the patients were divided into two a posteriori groups, mRS = 6 and mRS <6. Student’s t-test was used to compare these two groups in terms of brain symmetry index (BSI), National Institutes of Health stroke scale (NIHSS), Glasgow coma scale (GCS) and acute physiology and chronic health evaluation II (APACHE II) assessed at admission. Then EEG parameters, NIHSS, GCS and APACHE II were correlated with the mRS. Results There were significant differences in BSI, NIHSS, GCS, and APACHE II between the two groups. Survivors had lower BSI, NIHSS and APACHE II, and higher GCS values, compared with patients who died within 28 days after admission. Besides, BSI at admission had a positive correlation with mRS at 28 days (r = 0.441, P = 0.040). NIHSS and APACHE II were also correlated with mRS (r = 0.736, P <0.000 1; r = 0.667, P = 0.001, respectively). GCS at admission had a negative correlation with mRS (r = 0.656, P = 0.001). Conclusion A higher BSI predicts a poorer short-term prognosis for stroke patients. Acute EEG monitoring may be of prognostic value for 28-day outcomes. The early prediction of functional outcomes after stroke may enhance clinical management and minimize short-term mortality.     

应激性高血糖与前循环取栓再通后早期预后的相关性研究

目的 探讨应激性高血糖与急性前循环大血管闭塞取栓再通后早期预后的相关性。方法 本回顾性研究纳入于丽水市中心医院接受急诊取栓并成功再通的急性前循环大血管闭塞性缺血性卒中患者,成功再通定义为m TICI分级为2b～3级。依据应激性高血糖比值（stress hyperglycemia ratio,SHR）中位数将患者分为低SHR组和高SHR组,主要结局为出院功能预后不良（mRS评分4～6分）,次要结局为术后72 h内恶性脑水肿（malignant cerebral edema,MCE）。采用有序logistic回归分析SHR与出院mRS评分增加的关系,多因素logistic回归探究SHR与出院功能预后不良、MCE的相关性。结果 研究最终纳入312例患者,低SHR组与高SHR组各156(50%)例,SHR为0.953(0.817～1.100),静脉溶栓率为48.1%,NIHSS评分为14(11～18)分,72 h内发生MCE的有74例,出院功能预后不良的有196例。与低SHR组相比,高SHR组入院NIHSS评分更高（16分vs. 14分,P=0.031）,72 h内MCE发生率更高（33.3%...     

Long-Term Outcomes of Post-Thrombolytic Intracerebral Hemorrhage in Ischemic Stroke Patients

Background

Intracerebral hemorrhage (ICH) is an infrequent complication of intravenous recombinant tissue plasminogen activator (rt-PA) for the treatment of acute stroke. However, such ICH is an important reason for withdrawal of care because of lack of adequate data regarding long-term patient outcomes.

Objective

To report the long-term outcomes in patients with post-thrombolytic ICH.

Methods

We analyzed patient data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 h of symptom onset. Baseline clinical characteristics and outcomes defined by modified Rankin scale (mRS) were ascertained at 3, 6, and 12 months after treatment in patients who suffered from post-thrombolytic ICH. Favorable outcome was defined by mRS of 0–3 and unfavorable outcome by mRS of 4–6 at 1 year.

Results

A total of 48 patients suffered post-thrombolytic ICH in the trial. Fourteen patients had favorable outcomes and 34 patients had unfavorable outcomes. Clinical characteristics did not have an impact on patient outcomes at 12 months. Patients with unfavorable outcomes were more likely to have an National Institutes of Health Stroke Scale (NIHSS) score ≥20 at 7–10 days after treatment (64 vs. 7 %, p < 0.0009). Patients with unfavorable outcomes were more likely to have a worsening of NIHSS score of >4 points at 7–10 days from their baseline NIHSS (44 vs. 0 %, p = 0.0006).

Conclusion

Approximately 30 % of patients with post-thrombolytic ICH have favorable outcomes at 1 year which does not support early withdrawal of care. Ascertainment of NIHSS score and worsening of NIHSS score at 7–10 days may be necessary for accurate prognostic stratification.     

The association between fluid balance and outcomes after subarachnoid hemorrhage

Background

We sought to determine the association between early fluid balance and neurological/vital outcome of patients with subarachnoid hemorrhage.

Methods

Hospital admission, imaging, ICU and outcome data were retrospectively collected from the medical records of adult patients with aneurysmal SAH admitted to a level-1 trauma and stroke referral center during a 5-year period. Two groups were identified based on cumulative fluid balance by ICU day 3: (i) patients with a positive fluid balance (n?=?221) and (ii) patients with even or negative fluid balance (n?=?135). Multivariable logistic regression was used to adjust for age, Hunt-Hess and Fisher scores, mechanical ventilation and troponin elevation (>0.40?ng/ml) at ICU admission. The primary outcome was a composite of hospital mortality or new stroke.

Results

Patients with positive fluid balance had worse admission GCS and Hunt-Hess score, and by ICU day 3 had cumulatively received more IV fluids, but had less urine output when compared with the negative fluid balance group. There was no difference in the odds of hospital death or new stroke (adjusted OR: 1.47, 95%CI: 0.85, 2.54) between patients with positive and negative fluid balance. However, positive fluid balance was associated with increased odds of TCD vasospasm (adjusted OR 2.25, 95%CI: 1.37, 3.71) and prolonged hospital length of stay.

Conclusions

Although handling of IV fluid administration was not an independent predictor of mortality or new stroke, patients with early positive fluid balance had worse clinical presentation and had greater resource use during the hospital course.     

Care-needs Certification in the National Long-Term Care Insurance is Useful for Assessment of Premorbid Function in Older Japanese Patients with Stroke

ObjectiveTo investigate the effects of premorbid long-term care insurance (LTCI) care-need certification on functional improvement during acute hospitalization in older patients with stroke.MethodsIn this single-center prospective cohort study, we assessed LTCI care-needs certification and the modified Rankin Scale (mRS) at the premorbid stage, on admission, and at hospital discharge in older patients with stroke. We also assessed adverse events during hospitalization. The main outcome was the presence of functional improvement during hospitalization (mRS on admission < mRS at discharge). Multivariate analysis was performed to investigate the relationship between functional improvement and premorbid LTCI care-need certification.ResultsIn total, 246 older patients with stroke were enrolled in this study. There was a significant independent association between premorbid LTCI care-needs certification (care level 1 = odds ratio [OR]: 0.26, 95% CI: 0.10–0.72, p = 0.01; Care level 2 = OR: 0.27, 95% CI: 0.10–0.73, p = 0.01; care level 3–5 = OR: 0.21, 95% CI: 0.08–0.56, p = 0.002; Not applicable = reference) and functional improvement.ConclusionsPremorbid LTCI care-need certification is associated with short-term functional improvement in older patients with stroke. Assessment of premorbid LTCI care-needs certification is valid for predicting functional improvement in older patients with stroke.     

Preliminary findings of the effects of autonomic dysfunction on functional outcome after acute ischemic stroke

Background and purpose

Impaired autonomic function is common in the acute poststroke phase but little is known about its effects on functional outcome after acute ischemic stroke. This study sought to investigate the impact of autonomic dysfunction by Ewing's classification on functional outcome 2 months after acute ischemic stroke.

Methods

34 consecutive acute ischemic stroke patients within 7 days after onset were enrolled. On admission, autonomic function was assessed by Ewing's battery tests. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS), autonomy in activities of daily living by the Barthel Index (BI), and global disability by the modified Rankin Scale (mRS). BI and mRS were also evaluated 2 months after ischemic stroke onset.

Results

On admission, eight patients were diagnosed as minor autonomic dysfunction and 26 patients as relatively severe autonomic dysfunction. The prevalence of relatively severe autonomic dysfunction in ischemic stroke patients was 76.5%. There were no significant differences in baseline characteristics between the minor and severe autonomic dysfunction groups. 2 months after stroke onset, the mean BI score of patients with minor autonomic dysfunction and severe autonomic dysfunction increased from 76.3 ± 15.3 on admission to 95.0 ± 7.1, 66.5 ± 15.2 on admission to 74.8 ± 15.9 respectively. The mean BI score after 2-month stroke onset and the change in BI from admission to 2-month outcome (delta BI) in patients with severe autonomic dysfunction were lower than those in patients with minor autonomic dysfunction (all P < 0.05).

Conclusions

Autonomic dysfunction occurs in acute stroke patients. Relatively severe autonomic dysfunction is related to an unfavorable functional outcome in patients with acute ischemic stroke.     

代谢综合征对急性脑梗死早期预后的影响

目的 探讨急性脑梗死早期预后的影响因素，分析代谢综合征（metabolic syndrome，MS）是否为急性脑梗死早期预后的独立影响因素。方法 采用前瞻性研究设计，纳入连续性急性脑梗死163例，发病1个月时进行改良Rankin量表（mRS）评分作为结局变量，0=mRS 0～2，1=mRS 3～5；急诊入院时进行美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表（GCS）评分；依据病史及辅助检查确定TOAST分型。以性别、年龄、吸烟、饮酒、NIHSS评分、GCS评分、TOAST分型、合并症[感染、心肌梗死（MI）、心衰（HF）]、是否合并MS为自变量作单因素分析。多因素分析采用两分类logistic回归，自变量为多分类时采用变量哑化技术。结果 单因素分析结果发现，性别（P <0.05）、吸烟史（P＜0.05）、NIHSS评分（P <0.01）、GCS评分（P <0.01）、TOAST分型（P <0.01）、感染（P <0.01）、HF（P <0.05）、MS（P <0.01）对早期预后（mRS评分）的影响有统计学差异。多因素分析结果发现，MS（OR 3.869，95%CI 1.542～9.711，P <0.01）、NIHSS评分（OR 19.699，95%CI 2.107～184.134，P <0.01）、TOAST分型（OR 0.188，95%CI 0.067～0.525，P <0.01）、感染（OR 2.950，95%CI 1.202～7.238，P＜0.05）对mRS有统计学差异。结论 MS、NIHSS评分、TOAST分型、感染是预后差的独立危险因素。这对急性脑梗死的预后评价、对MS高危人群实施干预提供了可靠的依据。     

Elevated Urinary Titin and its Associated Clinical Outcomes after Acute Stroke

IntroductionUrinary titin is a biomarker of muscle atrophy, which is a serious complication after stroke. However, there are currently no clinical data regarding urinary titin in stroke patients.MethodsConsecutive stroke patients admitted to the stroke care unit were included. Spot urine samples were collected immediately after admission, and on days 3, 5, and 7. The primary outcome was the trend of urinary titin in patients after acute stroke. The secondary outcomes included the association between the peak urinary titin level and the modified Rankin Scale (mRS) score, the National Institutes of Health Stroke Scale (NIHSS) score, and the Barthel index (BI) upon hospital discharge. Multivariate analysis was adjusted for age, sex, NIHSS at admission, and the peak urinary titin to predict poor outcome (mRS 3–6).ResultsForty-one patients were included (29 male; age, 68 ± 15 years), 29 had ischemic stroke, 8 had intracerebral hemorrhage, and 4 had subarachnoid hemorrhage. The levels of urinary titin on days 1, 3, 5, and 7 were 9.9 (4.7–21.1), 16.2 (8.6–22.0), 8.9 (4.8–15.2), and 8.7 (3.6–16.2) pmol/mg Cr, respectively. The peak urinary titin level was associated with the mRS score (r = 0.55, p < 0.01), the NIHSS score (r = 0.72, p < 0.01), and the BI (r = ?0.59, p < 0.01) upon hospital discharge. In multivariate analysis, the peak urinary titin was associated with poor outcome (p = 0.03).ConclusionsUrinary titin rapidly increased after stroke and was associated with impaired functional outcomes at hospital discharge.     

Relation between lipoprotein-associated phospholipase A<Subscript>2</Subscript> mass and incident ischemic stroke severity

Background

Manifestations of ischemic stroke vary widely, and serum biomarkers may be useful for stratification of risk of severe stroke. This study evaluated the association of lipoprotein-associated phospholipase A₂ (Lp-PLA₂) mass and initial severity.

Methods

We employed a retrospective analysis on our hospital-based registry and recruited 488 first-onset ischemic stroke patients admitted within 24 h after onset and with Lp-PLA₂ mass measured. Stroke severities evaluated by National Institutes of Health Stroke Scale (NIHSS) were compared between Lp-PLA₂ categories dichotomized by median. Multivariate logistic regression was used to detect the independent risk factors of severe stroke (NIHSS ≥?7) and receiver operator curve (ROC) was constructed to detect the value of addition of Lp-PLA₂ to the model of other risk factors for predicting severe stroke.

Results

Of the overall patients, the median admission NIHSS scores was 3 and 28.1% had severe manifestation. Admission NIHSS scores were different between patients of Lp-PLA₂ above and under the median (median NIHSS 4 vs. 3, P?<?0.001). Lp-PLA₂ levels was correlated with admission NIHSS (r?=?0.268, P?<?0.001). Logistic regression showed Lp-PLA₂ category (OR 2.37, 95%CI 1.44–3.90, P?<?0.001) and levels per 100 ng/ml (OR 1.69, 95%CI 1.35–2.11, P?<?0.001) were both independently associated with severe stroke. Addition of Lp-PLA₂ category and levels to other independent risk factors both increased the area under curves (from 0.676 to 0.718 with category and 0.734 with levels).

Conclusion

Lp-PLA2 was independently related to admission severity in ischemic stroke patients, implying a potential predictive value of Lp-PLA2 for severe stroke in prevention.

     

Sex Differences in Stroke Incidence in a Portuguese Community-Based Study

Background and Aim

Stroke is a major health problem. Several studies reported sex differences regarding stroke. We aim to study this issue in an incidence stroke study.

National Institutes of Health Stroke Scale in patients with primary intracerebral hemorrhage

Background

The National Institutes of Health Stroke Scale (NIHSS) is able to predict mortality and functional outcome in patients with ischemic stroke. Its role in primary intracerebral hemorrhage (ICH) is not clear. The objective of our study was to investigate whether NIHSS is a reliable instrument of clinical monitoring and correlates with mortality and functional outcome in ICH.

Methods

One hundred fifty-six consecutive subjects with primary ICH were included. We evaluated NIHSS at admission. The functional state after a 30-day and a 3-month-long follow-up was assessed by the modified Rankin Scale (mRS). Spearman’s rank correlation coefficient analysis was used for statistics. Sensitivity, specificity, positive predictive value, negative predictive value, global accuracy, and ROC curve were computed using the median score 7 as NIHSS cutoff and the score 4 as mRS cutoff.

Results

Median NIHSS score at admission was 7 (16–4); the mean (± SD) was 10.82 (±?8.27). Thirty-two patients (20.5%) died within 30 days and other 22 (14.1%) within 3 months. The median mRS score at 3 months was 4 (6–1); the mean (± SD) was 3.38 (±?2.42). We found a statistically significant correlation between initial NIHSS score and mRS score after 30 days (0.74) and 3 months (0.66, p?<?0.01). Sensitivity was 93.5 and 92.2%, specificity 82.3 and 69.6%, and GA 87.8 and 80.8%, respectively, at 1 and 3 months. The 1- and 3-month ROC curves comparing initial NIHSS and mRS showed a fitted area as 0.914 and 0.833, respectively.

Conclusions

NIHSS is a reliable tool of clinical monitoring and correlates with 30-day and 3-month mortality and functional outcome in subjects with ICH.

     

Early Major Worsening in Ischemic Stroke: Predictors and Outcome

Introduction

We aimed to investigate the characteristics and outcome of patients suffering early major worsening (EMW) after acute ischemic stroke (AIS) and assess the parameters associated with it.

Methods

All consecutive patients with AIS in the ASTRAL registry until 10/2010 were included. EMW was defined as an NIHSS increase of ≥8 points within the first 24 h after admission. The Bootstrap version of the Kolmogorov–Smirnov test and the χ ²-test were used for the comparison of continuous and categorical covariates, respectively, between patients with and without EMW. Multiple logistic regression analysis was performed to identify independent predictors of EMW.

Results

Among 2155 patients, 43 (2.0 %) had an EMW. EMW was independently associated with hemorrhagic transformation (OR 22.6, 95 % CI 9.4–54.2), cervical artery dissection (OR 9.5, 95 % CI 4.4–20.6), initial dysarthria (OR 3.7, 95 % CI 1.7–8.0), and intravenous thrombolysis (OR 2.1, 95 % CI 1.1–4.3), whereas a negative association was identified with initial eye deviation (OR 0.4, 95 % CI 0.2–0.9). Favorable outcome at 3 and 12 months was less frequent in patients with EMW compared to patients without (11.6 vs. 55.3 % and 16.3 vs. 50.7 %, respectively), and case fatality was higher (53.5 vs. 12.9 % and 55.8 vs. 16.8 %, respectively). Stroke recurrence within 3 months in surviving patients was similar between patients with and without EMW (9.3 vs. 9.0 %, respectively).

Conclusions

Worsening of ≥8 points in the NIHSS score during the first 24 h in AIS patients is related to cervical artery dissection and hemorrhagic transformation. It justifies urgent repeat parenchymal and arterial imaging. Both conditions may be influenced by targeted interventions in the acute phase of stroke.     

Low-Density-Lipoprotein Particle Size Predicts a Poor Outcome in Patients with Atherothrombotic Stroke

Background and Purpose

Low-density lipoprotein (LDL) particle size is considered to be one of the more important cardiovascular risk factors, and small LDL particles are known to have atherogenic potential. The aim of this study was to determine whether LDL particle size is associated with stroke severity and functional outcome in patients with atherothrombotic stroke.

Methods

Between January 2009 and May 2011, 248 patients with first-episode cerebral infarction who were admitted to our hospital within 7 days after symptom onset were prospectively enrolled. LDL particle size was measured using the nondenaturing polyacrylamide gradient gel electrophoresis assay. Stroke severity was assessed by applying the National Institutes of Health Stroke Scale (NIHSS) at admission. Functional outcome was investigated at 3 months after the index stroke using the modified Rankin Scale (mRS), and poor functional outcome was defined as an mRS score of ≥3.

Results

The LDL particle size in the 248 patients was 25.9±0.9 nm (mean±SD). LDL particle size was inversely correlated with the degree of cerebral artery stenosis (p=0.010). Multinomial multivariate logistic analysis revealed that after adjustment for age, sex, and variables with p<0.1 in univariate analysis, LDL particle size was independently and inversely associated with stroke severity (NIHSS score ≥5; reference, NIHSS score 0-2; odds ratio=0.38, p=0.028) and poor functional outcome (odds ratio=0.44, p=0.038).

Conclusions

The results of this study demonstrate that small LDL particles are independently correlated with stroke outcomes. LDL particle size is thus a potential biomarker for the prognosis of atherothrombotic stroke.     

Predictive factors for the development of epilepsy after ischemic stroke

ObjectivesIschemic stroke is one of the most common causes of epilepsy in adults. The incidence of post-stroke epilepsy (PSE) is approximately 7%. Risk factors are higher stroke severity, cortical localization, higher National Institute of Health Stroke Scale (NIHSS) upon admission and acute symptomatic seizures. We analyzed the predictive factors of PSE development in our population.Materials and methodsRetrospective observational cohort of adult patients (age ≥ 18 years) with ischemic stroke assessed between January 2012 and June 2020. Patients with personal history of epilepsy and potentially epileptogenic structural injury other than acute or chronic stroke were excluded. Demographic, clinical and imaging variables were evaluated in a multivariate analysis for independent risk factors associated with PSE.ResultsMedical records of 1586 stroke patients were reviewed, 691 met the inclusion criteria and had at least one year of follow-up. Of them, 428 (61.9%) were males. During follow-up, 6.2% had diagnosis of PSE (42/691) with a higher frequency of: previous ischemic stroke, higher NIHSS upon admission, treatment with rt-PA, higher Fazekas scale grade, cortical involvement, hemorrhagic transformation, acute symptomatic seizures, longer hospitalization and higher modified Rankin Scale (mRS) at discharge compared to the group without PSE. In a multivariate analysis, acute symptomatic seizures (OR=3.22, p: 0.033), cortical involvement (OR=0.274, p < 0.05), Fazekas scale score (OR=0.519, p < 0.05) and mRS at discharge (OR=1.33, p: 0.043) were independent risk factors.ConclusionsThe variables related to higher risk of PSE were similar to those reported in the literature, highlighting the importance of neuroimaging findings, acute symptomatic seizures during hospitalization and neurological deficit at discharge. The data obtained will serve as the basis for construction of predictive models, allowing to individualize PSE probability in our population.     

Prognosis of Subtypes of Acute Large Artery Atherosclerotic Cerebral Infarction by Evaluation of Established Collateral Circulation

Background: The prognosis of acute ischemic stroke is related to collateral circulation, which is different with different pathogenesis. Objective: To explore the prognosis of acute large atherosclerotic (LAA) cerebral infarction with different pathogenesis by assessing the establishment of collateral circulation. Methods: 108 patients with acute LAA cerebral infarction in our hospital, who failed to thrombolytic or thrombectomy in the acute phase were selected and classified by Chinese ischemic stroke subclassification (CISS). They were evaluated by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). CT angiography (CTA) of head and neck were used to evaluate the collateral circulation for patients with large vessel stenosis or occlusion within one week of admission. The CTA collateral scores (CS) were recorded in a dichotomized fashion (ie, poor vs good). Results: Patients with good CS had significantly lower NIHSS score and good prognosis at 2 weeks and 3 months than patients with poor CS (P < 0.001). The arterial-to-arterial embolization mechanism was the highest in the ratio of good CS and good prognosis at 3 months (P < 0.001). Multivariate Logistic regression analysis showed that baseline NIHSS score (OR=1.407, 95%CI:1.153–1.717, P=0.001) was an independent factor affecting poor CS. The NIHSS score at baseline (OR=0.604, 95%CI:0.436–0.837, P=0.002) and good CS (OR=39.552, 95%CI:8.908–175.618, P=0.000) were important predictors of good prognosis at 3 months. Conclusion: The prognosis and collateral circulation of acute LAA cerebral infarction with different pathogenesis was different. Baseline NIHSS score and collateral circulation had great impact on prognosis at 3 months.