Factors predicting poor outcome at discharge in stroke patients with middle cerebral artery branch occlusion

Abstract

Objectives: To better determine the usefulness of mechanical thrombectomy for stroke patients with middle cerebral artery (MCA) branch occlusion, we investigated predictive factors related to poor outcome in acute, MCA branch occlusion stroke patients who had not undergone mechanical thrombectomy. Patients and methods: We retrospectively evaluated 204 consecutive acute stroke patients with MCA branch (M2-M4) occlusion. Two groups, based on activity of daily living scores at discharge, were compared: a dependent outcome group (mRS 3–6; n = 109) and an independent outcome group (mRS 0–2; n = 95), and the factors related to dependent outcomes at discharge determined. Results: The dependent group was older, had higher National Institutes of Health Stroke Scale (NIHSS) scores on admission, higher serum D-dimer and brain natriuretic peptide levels, and lower Alberta Stroke Program Early CT scores (ASPECTS) and rates of intravenous thrombolysis than the independent group. In multivariate analysis, age (OR 1.06; 95%CI 1.03–1.10), admission NIHSS score (OR 1.12; 95%CI 1.05–1.19), ASPECTS (OR 0.56; 95%CI 0.40–0.79), and intravenous thrombolysis (OR 0.22; 95%CI 0.08–0.57) were related to dependent outcomes. Decision curve analysis demonstrated that admission NIHSS scores were better predictors of dependency for threshold probabilities from 0.25 to 0.46. The optimal cutoff scores for predicting dependency were ≥8 (sensitivity 0.76, specificity 0.62) for the admission NIHSS score. Conclusions: Admission NIHSS scores might be useful predictors of dependent outcomes at discharge in acute ischemic stroke patients with MCA branch occlusion.

Keywords

• Middle cerebral artery branch occlusion
• Mechanical thrombectomy
• Decision curve analysis
• NIHSS score
• ASPECTS