Abstract Details

Title Association of Global Cortical Atrophy Score with Clinical Outcomes after Large Middle Cerebral Artery Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S20 - Cerebrovascular Disease and Interventional Neurology: Clinical Trials and Outcomes Studies (5:06 PM-5:18 PM)

Poster/Presentation
Number 009

Background

Life-threatening mass effect (LTME) is the most feared early complication after large ischemic stroke, occurring in up to 30-50% of patients with middle cerebral artery (MCA) occlusions. The effect of atrophy on the risk for swelling and its consequences is not well characterized. We hypothesized that a quantitative scale for global cortical atrophy (GCA) would significantly and inversely correlate with development of LTME.

Objective To determine the role of atrophy in predicting complications following large ischemic stroke

Design/Methods We performed a three-center, retrospective study of patients with ≥ 1/3 MCA territory infarct within 7 days of admission. We calculated a GCA score (0-3) using a standardized protocol. We performed univariate analyses to examine associations between atrophy and other factors including age, sex, and comorbidities for LTME. We constructed a multivariable model testing the association of LTME (defined as midline shift ≥ 5mm or decompressive hemicraniectomy) and GCA, adjusting for potential confounders including mechanical thrombectomy (MT), NIH stroke scale, and admission glucose.

Results

Of 560 patients who met our final inclusion criteria, median age [IQR] was 69.5 [58, 80] years, and 48% were female. 122 had no atrophy, 180 mild atrophy, 201 moderate atrophy, and 57 severe atrophy. Patients with lower atrophy scores had MT more often than those with higher scores (32.8% (none), 36.1% (mild), 19.4% (moderate), 26.3% (severe). There was also a significant difference in the death/hospice rates based on atrophy scores (15.6% (none), 33.3% (mild), 38.8% (moderate), 49.1% (severe)). We found that increased atrophy was significantly associated with decreased odds of LTME (OR [95% CI], 0.70 [0.52, 0.93]).

Conclusions Patients with large MCA stroke and various degrees of atrophy differ in both baseline characteristics and outcomes. Understanding how GCA affects risk of LTME has important implications for treatment and prognostication.

Authors/Disclosures
Rebecca Stafford (Boston Medical Center) PRESENTER	Ms. Stafford has nothing to disclose.
	No disclosure on file
	No disclosure on file
Benjamin Brush, MD (NYU Langone Neurology)	Dr. Brush has nothing to disclose.
Asim Z. Mian, MD (Boston University)	Dr. Mian has received personal compensation for serving as an employee of Boston Imaging Core Lab. Dr. Mian has stock in Boston Imaging Core Lab. Dr. Mian has received intellectual property interests from a discovery or technology relating to health care.
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. The institution of Dr. Greer has received research support from Becton, Dickinson and Company. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care.
Stelios M. Smirnakis, MD, PhD (Brigham and Women'S Hospital, Harvard Medical School)	An immediate family member of Dr. Smirnakis has received personal compensation for serving as an employee of Biogen Inc.. An immediate family member of Dr. Smirnakis has received stock or an ownership interest from Biogen. Dr. Smirnakis has received stock or an ownership interest from Photomedics Inc. The institution of Dr. Smirnakis has received research support from NIH. The institution of Dr. Smirnakis has received research support from Veterans Administration. The institution of Dr. Smirnakis has received research support from Emmetropia Inc. Dr. Smirnakis has received personal compensation in the range of $100,000-$499,999 for serving as a neurology staff with Veterans Administration.
Steven K. Feske, MD (Boston Medical Center, Neurology Department)	Dr. Feske has received publishing royalties from a publication relating to health care.
Charlene J. Ong, MD (Boston University)	Dr. Ong has nothing to disclose.