Poor Outcomes Related to Anterior Extension of Large Hemispheric Infarction: Topographic Analysis of GAMES-RP Trial MRI Scans.

Authors

Seyedmehdi Payabvash
Guido J Falcone
Gordon K Sze
Abhi Jain
Lauren A Beslow
Nils H Petersen
Kevin N Sheth
W Taylor Kimberly

Publication/Presentation Date

2-1-2020

Abstract

BACKGROUND: We aimed to assess the correlation of lesion location and clinical outcome in patients with large hemispheric infarction (LHI).

METHODS: We analyzed admission MRI data from the GAMES-RP trial, which enrolled patients with anterior circulation infarct volumes of 82-300 cm

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: 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: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01794182.

Volume

29

Issue

2

First Page

104488

Last Page

104488

ISSN

1532-8511

Published In/Presented At

Payabvash, S., Falcone, G. J., Sze, G. K., Jain, A., Beslow, L. A., Petersen, N. H., Sheth, K. N., & Kimberly, W. T. (2020). Poor Outcomes Related to Anterior Extension of Large Hemispheric Infarction: Topographic Analysis of GAMES-RP Trial MRI Scans. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 29(2), 104488. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104488

Disciplines

Medicine and Health Sciences | Pediatrics

PubMedID

31787498

Department(s)

Department of Pediatrics

Document Type

Article