Poor Outcomes Related to Anterior Extension of Large Hemispheric Infarction: Topographic Analysis of GAMES-RP Trial MRI Scans.
Administration, Intravenous
Aged
Anterior Cerebral Artery
/ diagnostic imaging
Cerebrovascular Circulation
Cerebrum
/ blood supply
Clinical Trials as Topic
Clinical Trials, Phase II as Topic
Diffusion Magnetic Resonance Imaging
Disability Evaluation
Extremities
/ innervation
Female
Glyburide
/ administration & dosage
Humans
Hypoglycemic Agents
/ administration & dosage
Infarction, Anterior Cerebral Artery
/ diagnostic imaging
Infarction, Middle Cerebral Artery
/ diagnostic imaging
Male
Middle Aged
Middle Cerebral Artery
/ diagnostic imaging
Patient Admission
Predictive Value of Tests
Recovery of Function
Risk Factors
Time Factors
Treatment Outcome
United States
Ischemic stroke
glibenclamide
glyburide
infarct location
lesion topography
malignant infarction
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
03
05
2019
revised:
09
10
2019
accepted:
15
10
2019
pubmed:
4
12
2019
medline:
19
2
2020
entrez:
3
12
2019
Statut:
ppublish
Résumé
We aimed to assess the correlation of lesion location and clinical outcome in patients with large hemispheric infarction (LHI). We analyzed admission MRI data from the GAMES-RP trial, which enrolled patients with anterior circulation infarct volumes of 82-300 cm We included 83 patients with known 3-month modified Rankin scale (mRS). In voxel-wise analysis, there was significant correlation between admission infarct lesions involving the anterior cerebral artery (ACA) territory and its middle cerebral artery (MCA) border zone with both higher 3-month mRS and post-stroke day 3 and 7 National Institutes of Health Stroke Scale (NIHSS) total score and arm/leg subscores. Higher NIHSS total scores from admission through poststroke day 2 correlated with left MCA infarcts. In multivariate analysis, ACA territory infarct volume (P = .001) and admission NIHSS (P = .005) were independent predictors of 3-month mRS. Moreover, in a subgroup of 36 patients with infarct lesions involving right MCA-ACA border zone, intravenous (IV) glibenclamide (BIIB093; glyburide) treatment was the only independent predictor of 3-month mRS in multivariate regression analysis (P = .016). Anterior extension of LHI with involvement of ACA territory and ACA-MCA border zone is an independent predictor of poor functional outcome, likely due to impairment of arm/leg motor function. If confirmed in larger cohorts, infarct topology may potentially help triage LHI patients who may benefit from IV glibenclamide. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01794182.
Sections du résumé
BACKGROUND
BACKGROUND
We aimed to assess the correlation of lesion location and clinical outcome in patients with large hemispheric infarction (LHI).
METHODS
METHODS
We analyzed admission MRI data from the GAMES-RP trial, which enrolled patients with anterior circulation infarct volumes of 82-300 cm
RESULTS
RESULTS
We included 83 patients with known 3-month modified Rankin scale (mRS). In voxel-wise analysis, there was significant correlation between admission infarct lesions involving the anterior cerebral artery (ACA) territory and its middle cerebral artery (MCA) border zone with both higher 3-month mRS and post-stroke day 3 and 7 National Institutes of Health Stroke Scale (NIHSS) total score and arm/leg subscores. Higher NIHSS total scores from admission through poststroke day 2 correlated with left MCA infarcts. In multivariate analysis, ACA territory infarct volume (P = .001) and admission NIHSS (P = .005) were independent predictors of 3-month mRS. Moreover, in a subgroup of 36 patients with infarct lesions involving right MCA-ACA border zone, intravenous (IV) glibenclamide (BIIB093; glyburide) treatment was the only independent predictor of 3-month mRS in multivariate regression analysis (P = .016).
CONCLUSIONS
CONCLUSIONS
Anterior extension of LHI with involvement of ACA territory and ACA-MCA border zone is an independent predictor of poor functional outcome, likely due to impairment of arm/leg motor function. If confirmed in larger cohorts, infarct topology may potentially help triage LHI patients who may benefit from IV glibenclamide.
CLINICAL TRIAL REGISTRATION
BACKGROUND
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01794182.
Identifiants
pubmed: 31787498
pii: S1052-3057(19)30572-5
doi: 10.1016/j.jstrokecerebrovasdis.2019.104488
pmc: PMC8820410
mid: NIHMS1774072
pii:
doi:
Substances chimiques
Hypoglycemic Agents
0
Glyburide
SX6K58TVWC
Banques de données
ClinicalTrials.gov
['NCT01794182']
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
104488Subventions
Organisme : NINR NIH HHS
ID : R01 NR018335
Pays : United States
Organisme : NINDS NIH HHS
ID : U24 NS107136
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS099209
Pays : United States
Organisme : NIA NIH HHS
ID : K76 AG059992
Pays : United States
Organisme : NINDS NIH HHS
ID : K23 NS076597
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG021342
Pays : United States
Organisme : NINDS NIH HHS
ID : U24 NS107215
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS106513
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS110721
Pays : United States
Informations de copyright
Copyright © 2019. Published by Elsevier Inc.
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