Association of Global Cortical Atrophy Score with Clinical Outcomes after Large Middle Cerebral Artery Stroke
Rebecca Stafford1, Stefanos Chatzidakis2, So Yeon Ivy Kim1, Ben Brush3, Asim Mian4, David Greer5, Stelios Smirnakis2, Steven Feske5, Charlene Ong4
1Boston University Medical Center, 2Brigham and Women's Hospital, Harvard Medical School, 3NYU Langone Health, 4Boston University, 5Boston University School of Medicine
Objective:
To determine the role of atrophy in predicting complications following large ischemic stroke
Background:
Life-threatening mass effect (LTME) is the most feared early complication after large ischemic stroke, occurring in up to 30-50% of patients with middle cerebral artery (MCA) occlusions. The effect of atrophy on the risk for swelling and its consequences is not well characterized. We hypothesized that a quantitative scale for global cortical atrophy (GCA) would significantly and inversely correlate with development of LTME.
Design/Methods:
We performed a three-center, retrospective study of patients with ≥ 1/3 MCA territory infarct within 7 days of admission. We calculated a GCA score (0-3) using a standardized protocol. We performed univariate analyses to examine associations between atrophy and other factors including age, sex, and comorbidities for LTME. We constructed a multivariable model testing the association of LTME (defined as midline shift ≥ 5mm or decompressive hemicraniectomy) and GCA, adjusting for potential confounders including mechanical thrombectomy (MT), NIH stroke scale, and admission glucose.
Results:
Of 560 patients who met our final inclusion criteria, median age [IQR] was 69.5 [58, 80] years, and 48% were female. 122 had no atrophy, 180 mild atrophy, 201 moderate atrophy, and 57 severe atrophy. Patients with lower atrophy scores had MT more often than those with higher scores (32.8% (none), 36.1% (mild), 19.4% (moderate), 26.3% (severe). There was also a significant difference in the death/hospice rates based on atrophy scores (15.6% (none), 33.3% (mild), 38.8% (moderate), 49.1% (severe)). We found that increased atrophy was significantly associated with decreased odds of LTME (OR [95% CI], 0.70 [0.52, 0.93]).
Conclusions:
Patients with large MCA stroke and various degrees of atrophy differ in both baseline characteristics and outcomes. Understanding how GCA affects risk of LTME has important implications for treatment and prognostication.