Endovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort

BackgroundRecent studies have demonstrated the superiority of endovascular therapy (EVT) for emergent large vessel occlusion.ObjectiveTo determine the effectiveness of EVT in nonagenarians, for whom data are limited.MethodsWe retrospectively reviewed clinical and imaging data of all patients who underwent EVT at two stroke centers between January 2012 and August 2014. The 90-day functional outcome (modified Rankin Scale (mRS) score) was compared between younger patients (age 18–89 years; n=175) and nonagenarians (n=18). The relationship between pre-stroke and 90-day post-stroke mRS was analyzed in these two groups. Multivariable analysis of age, recanalization grade, and admission National Institutes of Health Stroke Scale (NIHSS) for predicting outcome was performed.ResultsAge ≥90 years was associated with a poor (mRS >2) 90-day outcome relative to those under 90 (89% vs 52%, OR=8, 95% CI 1.7 to 35.0; p=0.0081). Nonagenarians had a higher pre-stroke mRS score (0.77; 95% CI 0.44 to 1.30) than younger patients (0.24; 95% CI 0.17 to 0.35; p=0.005). No difference was observed between nonagenarians and younger patients in the rate of mRS change from pre-stroke to 90 days (p=0.540). On multivariable regression, age (OR=1.05, 95% CI 1.03 to 1.08; p<0.0001), recanalization grade (OR=0.62 95% CI 0.42 to 0.91; p=0.015), and admission NIHSS (OR=1.07 95% CI 1.02 to 1.13; p=0.01) were associated with a poor 90-day outcome.ConclusionsNonagenarians are at a substantially higher risk of a poor 90-day outcome after EVT than younger patients. However, a small subset of nonagenarians may benefit from EVT, particularly if they have a good pre-stroke functional status. Further research is needed to identify factors associated with favorable outcome in this age cohort.

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Impact of Age on Short-term Outcomes After Lumbar Fusion

Neurosurgery ◽

10.1227/neu.0000000000000852 ◽

2015 ◽

Vol 77 (3) ◽

pp. 347-354 ◽

Cited By ~ 21

Author(s):

Mohamad Bydon ◽

Nicholas B. Abt ◽

Rafael De la Garza-Ramos ◽

Israel O. Olorundare ◽

Kelly McGovern ◽

...

Keyword(s):

Lumbar Fusion ◽

Multivariable Analysis ◽

The Elderly ◽

Complication Rates ◽

Improvement Program ◽

Younger Patients ◽

Age Cohorts ◽

Significant Difference ◽

Age Cohort ◽

Multivariable Regression

Abstract BACKGROUND: The safety and efficacy of spinal fusion in the elderly population remains uncertain with conflicting data. OBJECTIVE: To determine if elderly patients undergoing instrumented lumbar fusion have increased 30-day complication rates compared to younger patients. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was used to identify all patients undergoing instrumented posterolateral lumbar fusion between 2005 and 2011. Patients were stratified by decade cohorts as follows: <65, 65 to 75, 75 to 85, and ≥85 years old. All 30-day complications were grouped as overall composite morbidity and were compared using multivariate analysis. RESULTS: A total of 1395 patients were identified and the overall 30-day complication rate was 11.47%. The complication rates were 9.04% and 14.05% for patients younger than 65 and older than 65, respectively. When stratified by decade cohorts, the complication rates were 9.04% for the <65 cohort, 13.46% for the 65 to 75 cohort, 16.17% for the >75 to 85 cohort, and 4.00% for the ≥85 cohort. Multivariable regression analysis revealed no statistically significant difference between the <65 and ≥65 age cohorts (odds ratio = 1.26; 95% confidence interval: 0.87-2.19). After stratifying into age cohorts, multivariable analyses revealed no difference in odds of postoperative complication occurrence for any age cohort when compared with the referent group (<65 years of age). CONCLUSION: Patients older than 65 years of age have significantly higher rates of complications after lumbar fusion when compared to younger patients. However, multivariable analysis revealed that age was not an independent risk factor for complication occurrence after lumbar fusion.

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Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening

Cerebrovascular Diseases ◽

10.1159/000513396 ◽

2021 ◽

pp. 1-8

Author(s):

Ki-Woong Nam ◽

Chi Kyung Kim ◽

Sungwook Yu ◽

Jong-Won Chung ◽

Oh Young Bang ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Risk ◽

Multivariable Analysis ◽

National Institutes Of Health ◽

Risk Scores ◽

Stroke Patients ◽

Nihss Score ◽

Early Neurological Deterioration ◽

Close Relationship ◽

The Relationship

Background: Stroke risk scores (CHADS2 and CHA2DS2-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. Objective: The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. Methods: We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS2 and CHA2DS2-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. Results: A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA2DS2-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04–1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA2DS2-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA2DS2-VASc (aOR = 1.20, 95% CI = 1.04–1.38) and CHADS2 scores (aOR = 1.24, 95% CI = 1.01–1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. Conclusions: High CHA2DS2-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.

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Qualitative Posttreatment Diffusion-Weighted Imaging as a Predictor of 90-day Outcome in Stroke Intervention

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.330 ◽

2019 ◽

Vol 47 (2) ◽

pp. 160-166

Author(s):

Adam A Dmytriw ◽

Abdullah Alrashed ◽

Alejandro Enriquez-Marulanda ◽

Shadi Daghighi ◽

Ghouth Waggas ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Infarct Volume ◽

Multivariable Analysis ◽

Poor Performance ◽

Recombinant Tissue Plasminogen Activator ◽

National Institutes Of Health ◽

Infarct Core ◽

Vessel Occlusion ◽

Subjective Impression ◽

Diffusion Weighted

ABSTRACT:Purpose:The aim was to assess the ability of post-treatment diffusion-weighted imaging (DWI) to predict 90-day functional outcome in patients with endovascular therapy (EVT) for large vessel occlusion in acute ischemic stroke (AIS).Methods:We examined a retrospective cohort from March 2016 to January 2018, of consecutive patients with AIS who received EVT. Planimetric DWI was obtained and infarct volume calculated. Four blinded readers were asked to predict modified Rankin Score (mRS) at 90 days post-thrombectomy.Results:Fifty-one patients received endovascular treatment (mean age 65.1 years, median National Institutes of Health Stroke Scale (NIHSS) 18). Mean infarct volume was 43.7 mL. The baseline NIHSS, 24-hour NIHSS, and the DWI volume were lower for the mRS 0–2 group. Also, the thrombolysis in cerebral infarction (TICI) 2b/3 rate was higher in the mRS 0–2 group. No differences were found in terms of the occlusion level, reperfusion technique, or recombinant tissue plasminogen activator use. There was a significant association noted between average infarct volume and mRS at 90 days. On multivariable analysis, higher infarct volume was significantly associated with 90-day mRS 3–5 when adjusted to TICI scores and occlusion location (OR 1.01; CI 95% 1.001–1.03; p = 0.008). Area under curve analysis showed poor performance of DWI volume reader ability to qualitatively predict 90-day mRS.Conclusion:The subjective impression of DWI as a predictor of clinical outcome is poorly correlated when controlling for premorbid status and other confounders. Qualitative DWI by experienced readers both overestimated the severity of stroke for patients who achieved good recovery and underestimated the mRS for poor outcome patients. Infarct core quantitation was reliable.

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Acute Neurological Deterioration in Large Vessel Occlusions and Mild Symptoms Managed Medically

Stroke ◽

10.1161/strokeaha.119.027011 ◽

2020 ◽

Vol 51 (5) ◽

pp. 1428-1434 ◽

Cited By ~ 6

Author(s):

Yasir Saleem ◽

Raul G. Nogueira ◽

Gabriel M. Rodrigues ◽

Song Kim ◽

Vera Sharashidze ◽

...

Keyword(s):

Multivariable Analysis ◽

National Institutes Of Health ◽

Neurological Deterioration ◽

Large Vessel ◽

Minor Stroke ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Nihss Score ◽

Acute Neurological Deterioration

Background and Purpose— It is unclear which factors predict acute neurological deterioration in patients with large vessel occlusion and mild symptoms. We aim to evaluate the frequency, timing, and potential predictors of acute neurological deterioration ≥4 National Institutes of Health Stroke Scale (NIHSS) points in medically managed patients with large vessel occlusion and mild presentation. Methods— Single-center retrospective study of patients with consecutive minor stroke (defined as NIHSS score of ≤5 on presentation) and large vessel occlusion from January 2014 to December 2017. Primary outcome was acute neurological deterioration ≥4 NIHSS points during the hospitalization. Secondary outcomes included ΔNIHSS (defined as discharge minus admission NIHSS score). Results— Among 1133 patients with acute minor strokes, 122 (10.6%) had visible occlusions on computed tomography angiography/magnetic resonance angiography. Twenty-four (19.7%) patients had ≥4 points deterioration on NIHSS at a median of 3.6 (1–16) hours from arrival. No clinical or radiological predictors of acute neurological deterioration ≥4 NIHSS points were observed on multivariable analysis. Rescue endovascular thrombectomy was performed more often in the ones with acute neurological deterioration ≥4 NIHSS points compared with patients with no deterioration (54% versus 0%; P <0.001). Acute neurological deterioration ≥4 NIHSS points was associated with ΔNIHSS ≥4 points (33% versus 4.9%; P <0.01) and a trend toward lower independence rates at discharge (50% versus 70%; P =0.06) compared with the group with no deterioration. In patients with any degree of neurological worsening, patients who underwent rescue thrombectomy were more likely to be independent at discharge (73% versus 38%; P =0.02) and to have a favorable ΔNIHSS (−2 [−3 to 0] versus 0 [−1 to 6]; P =0.05) compared with the ones not offered rescue thrombectomy. Conclusions— Acute neurological deterioration ≥4 NIHSS points was observed in a fifth of patients with large vessel occlusion and mild symptoms, occurred very early in the hospital course, impacted functional outcomes, and could not be predicted by any of the studied clinical and radiological variables. Rescue thrombectomy was associated with improved clinical outcomes at discharge in patients with neurological deterioration.

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Abstract P543: Duration of Ischemia is Associated With Outcome After Endovascular Reperfusion Independent of Infarct Size

Stroke ◽

10.1161/str.52.suppl_1.p543 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Sunil A Sheth ◽

Osama O Zaidat ◽

Ameer E Hassan ◽

Johanna Fifi ◽

Ashish Nanda ◽

...

Keyword(s):

Propensity Score ◽

Elderly Patients ◽

Infarct Size ◽

Propensity Score Matching ◽

Multivariable Analysis ◽

Functional Independence ◽

Advanced Age ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Younger Patients

Introduction: Despite advanced imaging and rapid recanalization, the majority of patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) do not achieve functional independence at 90 days. Here, we explore the hypothesis that prolonged ischemia worsens clinical outcome beyond changes reflected in final infarct size, particularly in elderly patients. Methods: From the prospective, multicenter COMPLETE (Penumbra, Inc) registry, patients were included if they underwent endovascular therapy (EVT) for anterior circulation LVO, achieved TICI 2b/3 reperfusion, and EVT began within 90 minutes of imaging. Final infarct volumes (FIV) were measured on 24-48h post-EVT scans using ASPECTS. Multivariable logistic regression was used to determine the effect of stroke onset to hospital arrival time (OTA) on likelihood of functional independence (mRS 0-2) at 90 days, adjusting for age, NIHSS, occlusion location, pre-morbid mRS and final infarct. The effect of OTA on outcome was evaluated in older vs. younger patients using propensity score matching. Data are presented as median [IQR] or OR [95% CI]. Results: Among 302 patients, median age was 71 [61-79], NIHSS was 15 [10-20], 56% were female, median OTA was 154 [75-320]. Median FIV ASPECTS was 7 [6-8]. In multivariable analysis adjusting for FIV, longer OTA was associated with decreased likelihood of functional independence (OR 0.74 [0.57-0.96]). FIV-independent worsening with prolonged OTA was more pronounced with advanced age (Figure). Using propensity score matching, elderly patients (age > 70) matched by age, NIHSS, occlusion location and FIV were less likely to have functional independence with prolonged OTA (Coef -0.2, p<0.01), but not younger patients (age ≤ 70, Coef -0.1, p=0.3). Conclusions: In patients with LVO AIS who achieve successful reperfusion, delays in EVT reduce the likelihood of good clinical outcomes independent of FIV. This effect is more pronounced with advanced age.

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Abstract WP28: Factors Associated With Imaging and Endovascular Therapy Decisions for Mild Ischemic Stroke: An International Survey

Stroke ◽

10.1161/str.51.suppl_1.wp28 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Nastajjia A Krementz ◽

Avi Landman ◽

Hannah E Gardener ◽

Anny D Rodriguez ◽

Nicole B Sur ◽

...

Keyword(s):

Latin America ◽

Ischemic Stroke ◽

Multivariable Analysis ◽

Imaging Data ◽

Advanced Imaging ◽

Vessel Occlusion ◽

Factors Associated ◽

Mild Stroke ◽

Proximal Occlusion ◽

Level Training

Background: Approximately 1 in 7 patients with mild ischemic stroke (NIHSS ≤5) have large vessel occlusion (LVO). These patients were excluded from randomized trials of endovascular therapies (EVT). We conducted a survey to evaluate global practice patterns of EVT in mild stroke with LVO. Methods: International vascular stroke clinicians and interventionalists were invited to participate through professional stroke listservs. The survey consisted of 6 clinical vignettes of mild stroke patients with LVO (Table). Cases varied by NIHSS, neurological symptoms and LVO site. All had same risk factors, time from symptom onset (5h) and unremarkable head CT (high ASPECTS). Advanced imaging data was available upon request. We explored independent case and responder specific factors associated with advanced imaging request and EVT decision. Results: Of 492 responders, 482 had analyzable data ([median age 44 (IQR 11.25)], 78% male, 77% attending, 22% interventionalist). Participants were from USA (45%), Europe (32%), Australia (12%), Canada (6%), and Latin America (5%). EVT was offered to 48% (84% M1, 29% M2 and 19% A2). Treatment decision made without advanced imaging in 66%. In multivariable analysis, proximal occlusion (M1 vs M2 or A2, p<0.001), higher NIHSS (p<0.001) and fellow level training (vs attending; p=0.001) were positive predictors of EVT. Distal occlusion (M2 and A2) and higher age of responder were independently associated with increased advanced imaging requests. Compared to US and Australian responders, Canadians were less likely to offer EVT, while those in Europe and Latin America were more likely (p<0.05). Conclusions: Treatment patterns of EVT in mild stroke vary widely. More proximal occlusion, higher NIHSS, younger physician, fellow level training, and area of residence (Europe and Latin America) were key factors associated with offering EVT. These data suggest that wide equipoise exists in the current approach to this important subset of LVO stroke.

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Cryptogenic stroke

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000736 ◽

2019 ◽

Vol 10 (5) ◽

pp. 396-405

Author(s):

Shyam Prabhakaran ◽

Steven R. Messé ◽

Dawn Kleindorfer ◽

Eric E. Smith ◽

Gregg C. Fonarow ◽

...

Keyword(s):

Multivariable Analysis ◽

Cryptogenic Stroke ◽

National Institutes Of Health ◽

Large Artery ◽

Vessel Occlusion ◽

Stroke Registry ◽

Stroke Etiology ◽

Discharge Outcomes ◽

Get With The Guidelines ◽

Hospital Characteristics

BackgroundNationwide data on patients with cryptogenic stroke (CS) are lacking. We evaluated patient and hospital characteristics, in-hospital treatments, and discharge outcomes among patients with CS compared with other subtypes in the Get With The Guidelines (GWTG)-Stroke registry.MethodsWe identified patients with ischemic stroke (IS) admitted to GWTG-Stroke participating hospitals between January 1, 2016, and September 30, 2017, with documented National Institutes of Health Stroke Scale (NIHSS) scale and stroke etiology (cardioembolic [CE], large artery atherosclerosis [LAA], small vessel occlusion [SVO], other determined etiology [OTH], or CS). Using multivariable logistic regression, we compared hospital treatments and discharge outcomes by subtype, adjusted for patient and hospital characteristics.ResultsAmong 316,623 patients from 1,687 hospitals, there were 63,301 (20.0%) patients with CS. In multivariable analysis, patients with CS received IV thrombolysis more often than other subtypes and had lower mortality than CE, LAA, and OTH but higher mortality than SVO. They were more likely to be discharged home than all other subtypes and be independent at discharge than LAA, OTH, or SVO.ConclusionsIn a large contemporary nationwide registry, CS accounted for 20% of ISs among patients with a documented stroke etiology. Patients with CS had a distinct profile of treatments and outcomes relative to other subtypes. Improved subtype documentation and further research into CS are warranted to improve care and outcomes for patients with stroke.

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Relationship between reperfusion and intracranial hemorrhage after thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015337 ◽

2019 ◽

Vol 12 (5) ◽

pp. 448-453 ◽

Cited By ~ 1

Author(s):

Shashvat M Desai ◽

Daniel A Tonetti ◽

Andrew A Morrison ◽

Bradley A Gross ◽

Brian Thomas Jankowitz ◽

...

Keyword(s):

National Institutes Of Health ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Symptomatic Intracerebral Hemorrhage ◽

Stroke Study ◽

Monitoring Study ◽

Recorded Data ◽

Multivariable Analyses ◽

The Relationship

IntroductionSymptomatic intracerebral hemorrhage (sICH) is a devastating complication after endovascular thrombectomy. Prior reports have demonstrated that thrombolysis in cerebral infarction (TICI) ≥2 b reperfusion is protective against sICH. We aimed to further examine the relationship between reperfusion grade and sICH, to elucidate whether a difference between TICI 2b and 3 exists, and to determine whether this relationship holds true for patients undergoing delayed thrombectomy (6–24 hours).MethodsWe performed a single-center retrospective review of prospectively-recorded data for patients undergoing endovascular thrombectomy for large vessel occlusion between January 2015 and February 2018. Multivariable logistic regression analyses were performed to identify predictors of parenchymal hematoma (PH) and sICH (NINDS—National Institute of Neurological Disorders and Stroke, SITS-MOST—Safe Implementation of Thrombolysis in Stroke Monitoring Study, ECASS III—European-Australian Cooperative Acute Stroke Study III criteria) and to identify the role of reperfusion grade. This analysis was repeated for delayed thrombectomy patients.Results528 patients were included; mean age was 71.5% and 43% were male. Median NIHSS (National Institutes of Health Stroke Scale) and time last seen well (TLSW) to treatment were 17 and 4.8 hours, respectively. Successful recanalization was achieved in 94%. On multivariable analyses, ASPECTS (Alberta Stroke Programme Early CT Score) was a predictor of PH (OR 0.7, 95% CI 0.57 to 0.87; p=0.002) for patients achieving any reperfusion grade. For patients achieving successful reperfusion, lower ASPECTS was a predictor of PH (OR 0.73, 95% CI 0.58 to 0.91; p=0.005) and of sICH (ECASS III) (OR 0.67, 95% CI 0.45 to 0.98; p=0.04); in addition, TICI 2b as compared with TICI 3 was a predictor of PH (OR 2.1, 95% CI 1 to 4.4; p=0.04) and of sICH (NINDS) (OR 7.5, 95% CI 1 to 57; p=0.045). TLSW to treatment was not an independent predictor of PH or sICH.ConclusionHigher baseline ASPECTS and higher degree of reperfusion following endovascular thrombectomy is associated with reduced likelihood of PH and sICH.

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Ischemic lesion water homeostasis after thrombectomy for large vessel occlusion stroke within the anterior circulation: The impact of age

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x20915792 ◽

2020 ◽

Vol 41 (1) ◽

pp. 45-52 ◽

Cited By ~ 2

Author(s):

Lukas Meyer ◽

Michael Schönfeld ◽

Matthias Bechstein ◽

Uta Hanning ◽

Bastian Cheng ◽

...

Keyword(s):

Regression Analysis ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Edema Formation ◽

Ischemic Lesion ◽

Younger Patients ◽

Younger Age ◽

Multivariable Regression ◽

The Impact

The effect of age on lesion pathophysiology in the context of thrombectomy has been poorly investigated. We aimed to investigate the impact of age on ischemic lesion water homeostasis measured with net water uptake (NWU) within a multicenter cohort of patients receiving thrombectomy for anterior circulation large vessel occlusion (LVO) stroke. Lesion-NWU was quantified in multimodal CT on admission and 24 h for calculating Δ-NWU as their difference. The impact of age and procedural parameters on Δ-NWU was analyzed. Multivariable regression analysis was performed to identify significant predictors for Δ-NWU. Two hundred and four patients with anterior circulation stroke were included in the retrospective analysis. Comparison of younger and elderly patients showed no significant differences in NWU on admission but significantly higher Δ-NWU ( p = 0.005) on follow-up CT in younger patients. In multivariable regression analysis, higher age was independently associated with lowered Δ-NWU (95% confidence interval: −0.59 to −0.16, p < 0.001). Although successful recanalization (TICI ≥ 2b) significantly reduced Δ-NWU progression by 6.4% ( p < 0.001), younger age was still independently associated with higher Δ-NWU ( p < 0.001). Younger age is significantly associated with increased brain edema formation after thrombectomy for LVO stroke. Younger patients might be particularly receptive targets for future adjuvant neuroprotective drugs that influence ischemic edema formation.

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Abstract T P292: Baseline Infarct Volume Predicts Disability in TIA and Minor Stroke Patients

Stroke ◽

10.1161/str.45.suppl_1.tp292 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Negar Asdaghi ◽

jonathan Coulter ◽

Jayish Modi ◽

Abdul Qazi ◽

Mayank Goyal ◽

...

Keyword(s):

Tissue Injury ◽

Infarct Volume ◽

Recurrent Stroke ◽

Multivariable Analysis ◽

National Institutes Of Health ◽

Minor Stroke ◽

Predicting Outcome ◽

Ischemic Attack ◽

Symptom Progression ◽

The Impact

BACKGROUND: Despite their mild presenting neurological deficit, over one third of patients with transient ischemic attack (TIA) and minor stroke are dead or disabled at the time of hospital discharge. This is predominantly related to either symptom progression or recurrent stroke, although predicting outcome can be difficult. We sought to determine whether baseline radiographic MR characteristics could predict disability at 3months in this population. METHODS: Consecutive TIA/minor stroke (National Institutes of Health Stroke Scale<4) that were not disabled at baseline and had an MRI within 24 hours of symptom onset were prospectively included. Disability was assessed at 90 days using the modified Rankin Scale (mRS). The impact of perfusion (PWI) and diffusion (DWI) variables on disability (mRS≥2) at 90 days was assessed. RESULTS: 418 patients were included; 55.5% had positive DWI lesions. 292 patients had PWI imaging of whom 35% had PWI deficit (Tmax≥2s) and 26.5% had mismatch (Tmax≥4s-DWI) at baseline. The median DWI, PWI and mismatch volumes were 1.14 ml (IQR=3.43), 9.8 ml (IQR=29.8) and 9 ml respectively. A total of 56/418 (13.4%) patients were disabled at 90days. In multivariable analysis we adjusted for baseline predictors of disability (age, DM, premorbid mRS 1, ongoing symptoms, baseline NIHSS, CT/CT angiography-positive metric and DWI or PWI volume). DWI volume (OR=1.05, p=0.007), and age (OR=1.03, p=0.003) remained independent predictors of disability. PWI or mismatch volume did not predict functional outcome. CONCLUSIONS: A substantial proportion of patients with TIA and minor stroke are disabled at 90days. The degree of tissue injury as measured by DWI volume is an independent predictor of disability regardless of the mechanism of disability.

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