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01.08.2014 | ORIGINAL ARTICLE

Outcomes in Severe Middle Cerebral Artery Ischemic Stroke

verfasst von: Brian P. Walcott, Jennifer C. Miller, Churl-Su Kwon, Sameer A. Sheth, Marc Hiller, Carolyn A. Cronin, Lee H. Schwamm, J. Marc Simard, Kristopher T. Kahle, W. Taylor Kimberly, Kevin N. Sheth

Erschienen in: Neurocritical Care | Ausgabe 1/2014

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Abstract

Background

Severe middle cerebral artery stroke (MCA) is associated with a high rate of morbidity and mortality. We assessed the hypothesis that patient-specific variables may be associated with outcomes. We also sought to describe under-recognized patient-centered outcomes.

Methods

A consecutive, multi-institution, retrospective cohort of adult patients (≤70 years) was established from 2009 to 2011. We included patients with NIHSS score ≥15 and infarct volume ≥60 mL measured within 48 h of symptom onset. Malignant edema was defined as the development of midline brain shift of ≥5 mm in the first 5 days. Exclusion criterion was enrollment in any experimental trial. A univariate and multivariate logistic regression analysis was performed to model and predict the factors related to outcomes.

Results

46 patients (29 female, 17 male; mean age 57.3 ± 1.5 years) met study criteria. The mortality rate was 28 % (n = 13). In a multivariate analysis, only concurrent anterior cerebral artery (ACA) involvement was associated with mortality (OR 9.78, 95 % CI 1.15, 82.8, p = 0.04). In the malignant edema subgroup (n = 23, 58 %), 4 died (17 %), 7 underwent decompressive craniectomy (30 %), 7 underwent tracheostomy (30 %), and 15 underwent gastrostomy (65 %).

Conclusions

Adverse outcomes after severe stroke are common. Concurrent ACA involvement predicts mortality in severe MCA stroke. It is useful to understand the incidence of life-sustaining procedures, such as tracheostomy and gastrostomy, as well as factors that contribute to their necessity.

Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Carnethon MR, Dai S, de Simone G, Ford ES. Executive summary: heart disease and stroke statistics—2011 update a report from the American Heart Association. Circulation. 2011;123(4):459–63.CrossRef

Qureshi AI, Suri MFK, Nasar A, Kirmani JF, Ezzeddine MA, Divani AA, Giles WH. Changes in cost and outcome among US patients with stroke hospitalized in 1990 to 1991 and those hospitalized in 2000 to 2001. Stroke. 2007;38(7):2180–4.CrossRefPubMed

Mayer SA, Copeland D, Bernardini GL, Boden-Albala B, Lennihan L, Kossoff S, Sacco RL. Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke. 2000;31(10):2346–53.CrossRefPubMed

Warach S, Dashe JF, Edelman RR. Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: a preliminary analysis. J Cereb Blood Flow Metab. 1996;16(1):53–9.CrossRefPubMed

Sacco RL. Risk factors and outcomes for ischemic stroke. Neurology. 1995;45(2 Suppl 1):S10.PubMed

Castillo J, Leira R, García MM, Serena J, Blanco M, Dávalos A. Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor stroke outcome. Stroke. 2004;35(2):520–6.CrossRefPubMed

Oppenheim C, Samson Y, Manai R, Lalam T, Vandamme X, Crozier S, Srour A, Cornu P, Dormont D, Rancurel G. Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging. Stroke. 2000;31(9):2175–81.CrossRefPubMed

Thomalla GJ, Kucinski T, Schoder V, Fiehler J, Knab R, Zeumer H, Weiller C, Röther J. Prediction of malignant middle cerebral artery infarction by early perfusion-and diffusion-weighted magnetic resonance imaging. Stroke. 2003;34(8):1892–9.CrossRefPubMed

Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. ‘Malignant’middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996;53(4):309.CrossRefPubMed

10.

Krieger DW, Demchuk AM, Kasner SE, Jauss M, Hantson L. Early clinical and radiological predictors of fatal brain swelling in ischemic stroke. Stroke. 1999;30(2):287–92.CrossRefPubMed

11.

Smith EE, Shobha N, Dai D, Olson DM, Reeves MJ, Saver JL, Hernandez AF, Peterson ED, Fonarow GC, Schwamm LH. Risk score for in-hospital ischemic stroke mortality derived and validated within the get with the Guidelines-Stroke Program. Circulation. 2010;122(15):1496–504.CrossRefPubMed

12.

Sims J, Gharai LR, Schaefer P, Vangel M, Rosenthal E, Lev M, Schwamm L. ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology. 2009;72(24):2104–10.PubMedCentralCrossRefPubMed

13.

Pullicino P, Alexandrov A, Shelton J, Alexandrova N, Smurawska L, Norris J. Mass effect and death from severe acute stroke. Neurology. 1997;49(4):1090–5.CrossRefPubMed

14.

Ribo M, Molina CA, Rovira A, Quintana M, Delgado P, Montaner J, Grivé E, Arenillas JF, Álvarez-Sabín J. Safety and efficacy of intravenous tissue plasminogen activator stroke treatment in the 3-to 6-hour window using multimodal transcranial Doppler/MRI selection protocol. Stroke. 2005;36(3):602–6.CrossRefPubMed

15.

Abou-Chebl A. Endovascular treatment of acute ischemic stroke may be safely performed with no time window limit in appropriately selected patients. Stroke. 2010;41(9):1996–2000.CrossRefPubMed

16.

Lees KR, Bluhmki E, Von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375(9727):1695.CrossRefPubMed

17.

Walcott BP, Kahle KT, Simard JM. Novel treatment targets for cerebral edema. Neurotherapeutics. 2012;9(1):65–72.

18.

Sheth KN, Kimberly WT, Elm J, Yarbrough K, O’Connor S, Hammer M, Kane A, Busl K, Cole T, Yoo AJ et al. GAMES (Glyburide Advantage in Malignant Edema and Stroke) Pilot Study In: International Stroke Conference. Hawaii; 2013.

19.

Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380(9849):1231–40.CrossRefPubMed

20.

Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012;380(9849):1241–9.CrossRefPubMed

21.

Meyers PM, Schumacher HC, Connolly ES Jr, Heyer EJ, Gray WA, Higashida RT. Current status of endovascular stroke treatment. Circulation. 2011;123(22):2591–601.PubMedCentralCrossRefPubMed

22.

Nogueira R, Schwamm L, Hirsch J. Endovascular approaches to acute stroke, part 1: drugs, devices, and data. AJNR Am J Neuroradiol. 2009;30(4):649–61.CrossRefPubMed

23.

Nogueira R, Yoo A, Buonanno F, Hirsch J. Endovascular approaches to acute stroke, part 2: a comprehensive review of studies and trials. AJNR Am J Neuroradiol. 2009;30(5):859–75.CrossRefPubMed

24.

Brinjikji W, Rabinstein AA, Kallmes DF, Cloft HJ. Patient outcomes with endovascular embolectomy therapy for acute ischemic stroke a study of the national inpatient sample: 2006 to 2008. Stroke. 2011;42(6):1648–52.CrossRefPubMed

25.

Jüttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, Woitzik J, Witte S, Jenetzky E, Hacke W. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY) a randomized, controlled trial. Stroke. 2007;38(9):2518–25.CrossRefPubMed

26.

Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, Boutron C, Couvreur G, Rouanet F, Touzé E. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007;38(9):2506–17.CrossRefPubMed

27.

Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB. Surgical decompression for space-occupying cerebral infarction (the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8(4):326–33.CrossRefPubMed

28.

Walcott BP, Kuklina EV, Nahed BV, George MG, Kahle KT, Simard JM, Asaad WF, Coumans JVCE. Craniectomy for malignant cerebral infarction: prevalence and outcomes in US Hospitals. PLoS ONE. 2011;6(12):e29193.PubMedCentralCrossRefPubMed

29.

Pervez MA, Silva G, Masrur S, Betensky RA, Furie KL, Hidalgo R, Lima F, Rosenthal ES, Rost N, Viswanathan A. Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke. 2010;41(1):e18–24.PubMedCentralCrossRefPubMed

30.

Schwamm LH, Holloway RG, Amarenco P, Audebert HJ, Bakas T, Chumbler NR, Handschu R, Jauch EC, Knight WA, Levine SR. A review of the evidence for the use of telemedicine within stroke systems of care a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2009;40(7):2616–34.CrossRefPubMed

31.

Coyle P, Heistad DD. Blood flow through cerebral collateral vessels one month after middle cerebral artery occlusion. Stroke. 1987;18(2):407–11.CrossRefPubMed

32.

Souza L, Yoo A, Chaudhry Z, Payabvash S, Kemmling A, Schaefer P, Hirsch J, Furie K, González R, Nogueira R. Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke. AJNR Am J Neuroradiol. 2012;33(7):1331–6.PubMedCentralCrossRefPubMed

33.

Tan I, Demchuk A, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons S, Fox A, Aviv R. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol. 2009;30(3):525–31.CrossRefPubMed

34.

Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, Harris GJ, Halpern E, Kemmling A, Koroshetz WJ. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke. 2009;40(9):3001–5.PubMedCentralCrossRefPubMed

35.

Kasner SE, Demchuk AM, Berrouschot J, Schmutzhard E, Harms L, Verro P, Chalela JA, Abbur R, McGrade H, Christou I. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke. 2001;32(9):2117–23.CrossRefPubMed

36.

Jaramillo A, Gongora-Rivera F, Labreuche J, Hauw JJ, Amarenco P. Predictors for malignant middle cerebral artery infarctions a postmortem analysis. Neurology. 2006;66(6):815–20.CrossRefPubMed

37.

Simard JM, Chen M, Tarasov KV, Bhatta S, Ivanova S, Melnitchenko L, Tsymbalyuk N, West GA, Gerzanich V. Newly expressed SUR1-regulated NCCa-ATP channel mediates cerebral edema after ischemic stroke. Nat Med. 2006;12(4):433–40.PubMedCentralCrossRefPubMed

38.

Rordorf G, Koroshetz W, Efird JT, Cramer SC. Predictors of mortality in stroke patients admitted to an intensive care unit. Crit Care Med. 2000;28(5):1301.CrossRefPubMed

39.

Burtin P, Bollaert P, Feldmann L, Nace L, Lelarge P, Bauer P, Larcan A. Prognosis of stroke patients undergoing mechanical ventilation. Intensive Care Med. 1994;20(1):32–6.CrossRefPubMed

40.

Gujjar A, Deibert E, Manno E, Duff S, Diringer M. Mechanical ventilation for ischemic stroke and intracerebral hemorrhage Indications, timing, and outcome. Neurology. 1998;51(2):447–51.CrossRefPubMed

41.

Steiner T, Mendoza G, De Georgia M, Schellinger P, Holle R, Hacke W. Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke. 1997;28(4):711–5.CrossRefPubMed

42.

Menon SC, Pandey DK, Morgenstern LB. Critical factors determining access to acute stroke care. Neurology. 1998;51(2):427–32.CrossRefPubMed

43.

Feigin VL, Lawes CMM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355–69.CrossRefPubMed

44.

Petty GW, Brown RD Jr, Whisnant JP, Sicks JRD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke. 1999;30(12):2513–6.CrossRefPubMed

45.

Kleindorfer D, Lindsell CJ, Brass L, Koroshetz W, Broderick JP. National US estimates of recombinant tissue plasminogen activator Use ICD-9 codes substantially underestimate. Stroke. 2008;39(3):924–8.CrossRefPubMed

46.

Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719–48.PubMed

47.

Mehta B, Leslie-Mazwi T, Chandra R, Chaudhry Z, Rabinov J, Hirsch J, Schwamm L, Rost N, Yoo A. Assessing variability in neurointerventional practice patterns for acute ischemic stroke. J Neurointerv Surg. 2013;5:i52–7.

48.

Reeves MJ, Gargano J, Maier KS, Broderick JP, Frankel M, LaBresh KA, Moomaw CJ, Schwamm L. Patient-level and hospital-level determinants of the quality of acute stroke care a multilevel modeling approach. Stroke. 2010;41(12):2924–31.CrossRefPubMed

49.

Desai A, Bekelis K, Zhao W, Ball PA, Erkmen K. Association of a higher density of specialist neuroscience providers with fewer deaths from stroke in the United States population. J Neurosurg. 2013;118(2):431–6.

Titel: Outcomes in Severe Middle Cerebral Artery Ischemic Stroke
verfasst von: Brian P. Walcott
Jennifer C. Miller
Churl-Su Kwon
Sameer A. Sheth
Marc Hiller
Carolyn A. Cronin
Lee H. Schwamm
J. Marc Simard
Kristopher T. Kahle
W. Taylor Kimberly
Kevin N. Sheth
Publikationsdatum: 01.08.2014
Verlag: Springer US
Erschienen in: Neurocritical Care / Ausgabe 1/2014
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-013-9838-x

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