Value of infarct location in the prediction of functional outcome in patients with an anterior large vessel occlusion: results from the HERMES study

Tolhuisen, M. L. et al. (2022) Value of infarct location in the prediction of functional outcome in patients with an anterior large vessel occlusion: results from the HERMES study. Neuroradiology, 64(3), pp. 521-530. (doi: 10.1007/s00234-021-02784-x) (PMID:34476512)

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Purpose: Follow-up infarct volume (FIV) is moderately associated with functional outcome. We hypothesized that accounting for infarct location would strengthen the association of FIV with functional outcome. Methods: We included 252 patients from the HERMES collaboration with follow-up diffusion weighted imaging. Patients received endovascular treatment combined with best medical management (n = 52%) versus best medical management alone (n = 48%). FIV was quantified in low, moderate and high modified Rankin Scale (mRS)-relevant regions. We used binary logistic regression to study the relation between the total, high, moderate or low mRS-relevant FIVs and favorable outcome (mRS < 2) after 90 days. The strength of association was evaluated using the c-statistic. Results: Small lesions only occupied high mRS-relevant brain regions. Lesions additionally occupied lower mRS-relevant brain regions if FIV expanded. Higher FIV was associated with a higher risk of unfavorable outcome, as were volumes of tissue with low, moderate and high mRS relevance. In multivariable modeling, only the volume of high mRS-relevant infarct was significantly associated with favorable outcome. The c-statistic was highest (0.76) for the models that included high mRS-relevant FIV or the combination of high, moderate and low mRS-relevant FIV but was not significantly different from the model that included only total FIV (0.75). Conclusion: This study confirms the association of FIV and unfavorable functional outcome but showed no strengthened association if lesion location was taken into account.

Item Type:Articles
Additional Information:The CONTRAST consortium is supported by Netherlands Cardiovascular Research Initiative (CVON), an initiative of the Dutch Heart Foundation, by the Brain Foundation Netherlands, Medtronic and Cerenovus. AMC and Erasmus MC received additional unrestricted funding on behalf of CONTRAST, for the execution of MR CLEAN NO-IV from Stryker European Operations BV.
Glasgow Author(s) Enlighten ID:Muir, Professor Keith
Authors: Tolhuisen, M. L., Ernst, M., Boers, A. M.M., Brown, S., Beenen, L. F.M., Guillemin, F., Roos, Y. B.W.E.M., Saver, J. L., van Oostenbrugge, R., Demchuck, A. M., van Zwam, W., Jovin, T. G., Berkhemer, O. A., Muir, K. W., Bracard, S., Campbell, B. C.V., van der Lugt, A., White, P., Hill, M. D., Dippel, D. W.J., Mitchell, P. J., Goyal, M., Caan, M. W.A., Marquering, H. A., and Majoie, C. B.L.M.
College/School:College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
Journal Name:Neuroradiology
ISSN (Online):1432-1920
Published Online:03 September 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Neuroradiology 64(3): 521-530
Publisher Policy:Reproduced under a Creative Commons License

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