Genetic Predisposition to Mosaic Chromosomal Loss Is Associated With Functional Outcome After Ischemic Stroke

Background and ObjectivesTo test the hypothesis that a predisposition to acquired genetic alterations is associated with ischemic stroke outcome by investigating the association between a polygenic risk score (PRS) for mosaic loss of chromosome Y (mLOY) and outcome in a large international data set.MethodsWe used data from the genome-wide association study performed within the Genetics of Ischemic Stroke Functional Outcome network, which included 6,165 patients (3,497 men and 2,668 women) with acute ischemic stroke of mainly European ancestry. We assessed a weighted PRS for mLOY and examined possible associations with the modified Rankin Scale (mRS) score 3 months poststroke in logistic regression models. We investigated the whole study sample as well as men and women separately.ResultsIncreasing PRS for mLOY was associated with poor functional outcome (mRS score >2) with an odds ratio (OR) of 1.11 (95% confidence interval [CI] 1.03–1.19) per 1 SD increase in the PRS after adjustment for age, sex, ancestry, stroke severity (NIH Stroke Scale), smoking, and diabetes mellitus. In sex-stratified analyses, we found a statistically significant association in women (adjusted OR 1.20, 95% CI 1.08–1.33). In men, the association was in the same direction (adjusted OR 1.04, 95% CI 0.95–1.14), and we observed no significant genotype-sex interaction.DiscussionIn this exploratory study, we found associations between genetic variants predisposing to mLOY and stroke outcome. The significant association in women suggests underlying mechanisms related to genomic instability that operate in both sexes. These findings need replication and mechanistic exploration.

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Polygenic Risk Scores Augment Stroke Subtyping

Neurology Genetics ◽

10.1212/nxg.0000000000000560 ◽

2021 ◽

Vol 7 (2) ◽

pp. e560

Author(s):

Jiang Li ◽

Durgesh P. Chaudhary ◽

Ayesha Khan ◽

Christoph Griessenauer ◽

David J. Carey ◽

...

Keyword(s):

Ischemic Stroke ◽

Genetic Correlation ◽

Genome Wide Association Study ◽

Low Frequency ◽

European Ancestry ◽

Risk Scores ◽

Polygenic Risk Score ◽

Large Artery ◽

Polygenic Risk ◽

Gene Sets

ObjectiveTo determine whether the polygenic risk score (PRS) derived from MEGASTROKE is associated with ischemic stroke (IS) and its subtypes in an independent tertiary health care system and to identify the PRS derived from gene sets of known biological pathways associated with IS.MethodsControls (n = 19,806/7,484, age ≥69/79 years) and cases (n = 1,184/951 for discovery/replication) of acute IS with European ancestry and clinical risk factors were identified by leveraging the Geisinger Electronic Health Record and chart review confirmation. All Geisinger MyCode patients with age ≥69/79 years and without any stroke-related diagnostic codes were included as low risk control. Genetic heritability and genetic correlation between Geisinger and MEGASTROKE (EUR) were calculated using the summary statistics of the genome-wide association study by linkage disequilibrium score regression. All PRS for any stroke (AS), any ischemic stroke (AIS), large artery stroke (LAS), cardioembolic stroke (CES), and small vessel stroke (SVS) were constructed by PRSice-2.ResultsA moderate heritability (10%–20%) for Geisinger sample as well as the genetic correlation between MEGASTROKE and the Geisinger cohort was identified. Variation of all 5 PRS significantly explained some of the phenotypic variations of Geisinger IS, and the R2 increased by raising the cutoff for the age of controls. PRSLAS, PRSCES, and PRSSVS derived from low-frequency common variants provided the best fit for modeling (R2 = 0.015 for PRSLAS). Gene sets analyses highlighted the association of PRS with Gene Ontology terms (vascular endothelial growth factor, amyloid precursor protein, and atherosclerosis). The PRSLAS, PRSCES, and PRSSVS explained the most variance of the corresponding subtypes of Geisinger IS suggesting shared etiologies and corroborated Geisinger TOAST subtyping.ConclusionsWe provide the first evidence that PRSs derived from MEGASTROKE have value in identifying shared etiologies and determining stroke subtypes.

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Prognostic value of myocardial MIBG scintigraphy in acute ischemic stroke

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.028 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

S Bourgeois ◽

I Peeters ◽

G Vanderschueren ◽

A Nous ◽

J De Keyser ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Univariate Analysis ◽

Washout Rate ◽

Stroke Severity ◽

Stroke Outcome ◽

Mibg Scintigraphy ◽

Poor Functional Outcome ◽

Funding Sources

Abstract Funding Acknowledgements Type of funding sources: None. Background Autonomic dysfunction is a common complication of acute ischemic stroke and has been associated with poor functional outcome and increased mortality. We investigated the potential relation between the myocardial washout rate (WOR) of 123I-meta-iodobenzylguanidine (123I-mIBG), as a measure of cardiac sympathetic activity, and functional outcome in acute ischemic stroke. Methods 38 patients with ischemic stroke (11 females, 72 years old [61-81)), underwent myocardial 123I-mIBG scintigraphy within the first week after stroke onset. Early (10 minutes post-injection (pi)) and late (4 hours pi) planar scans of the thoracic region were made. Regions of interest (ROI) were drawn over the mediastinum and the heart, and heart-to-mediastinum ratio (HMR) was calculated. Myocardial WOR was calculated as follows: (ROI heart early – ROI heart late)/ (ROI heart early) x 100%. Counts were corrected for background and counts in ROI heart late were corrected for decay. Patients were divided in 2 groups: those with a good functional outcome, defined as modified Rankin Scale (mRS) ≤ 2 at 3 months after stroke (i.e., patient is functionally independent), and those with a poor functional outcome, defined as a mRS > 2. Results Median WOR was 27,4 % (IQR 10,4-43,6). In univariate analysis, poor functional outcome after stroke was associated with age, stroke severity on admission (measured by the National Institutes of Health Stroke Scale (NIHSS)), beta-blocker use before and during hospitalization, WOR and late HMR. In subsequent multivariate analysis WOR (OR 1.087; 95% CI 1.003-1.177, p = 0.042) was an independent predictor of poor stroke outcome even after adjustment for age and NIHSS. Conclusions In patients with acute ischemic stroke, myocardial washout of 123I-mIBG predicts stroke outcome, even after adjustment for age and stroke severity on admission.

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Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia: The Fukuoka Stroke Registry

Cerebrovascular Diseases ◽

10.1159/000514368 ◽

2021 ◽

pp. 1-7

Author(s):

Yoshinobu Wakisaka ◽

Ryu Matsuo ◽

Kuniyuki Nakamura ◽

Tetsuro Ago ◽

Masahiro Kamouchi ◽

...

Keyword(s):

Cohort Study ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Neurological Deterioration ◽

Stroke Outcome ◽

Matched Cohort ◽

Poor Functional Outcome ◽

Stroke Registry ◽

Chei Treatment

Introduction: Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia. Methods: We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3–6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study. Results: Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46–0.99]) and neurological deterioration (0.52 [0.31–0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40–0.92]) and between the treatment and neurological deterioration (0.47 [0.25–0.86]). Conclusions: Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.

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Genetic variation at the IGF1 locus shows association with post-stroke outcome and to circulating IGF1

Acta Endocrinologica ◽

10.1530/eje-13-0486 ◽

2013 ◽

Vol 169 (6) ◽

pp. 759-765 ◽

Cited By ~ 17

Author(s):

N David Åberg ◽

Sandra Olsson ◽

Daniel Åberg ◽

Katarina Jood ◽

Tara M Stanne ◽

...

Keyword(s):

Genetic Variation ◽

Ischemic Stroke ◽

Stroke Severity ◽

Stroke Outcome ◽

Nucleotide Polymorphisms ◽

Post Stroke ◽

Index Stroke ◽

Genetic Impact ◽

Major Allele ◽

Community Controls

ObjectiveIn humans, serum IGF1 (s-IGF1) is associated with outcome after ischemic stroke (IS). Therefore variation at the IGF1 locus could also associate with both IS and s-IGF1. We investigated whether genetic variation at the IGF1 locus is associated with i) s-IGF1, ii) IS occurrence, iii) IS severity, and iv) post-stroke outcome.Design/methodsPatients (n=844; 66% males, mean age 56 years) and community controls (n=668) were included from the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). Post-stroke outcome was evaluated with the modified Rankin Scale at 3 and 24 months after index stroke, and baseline stroke severity with the Scandinavian Stroke Scale. s-IGF1 was determined in patients and after random selection in 40 of the controls.ResultsEleven single nucleotide polymorphisms (SNPs) were selected in the IGF1 gene. In healthy controls the major allele of rs7136446 was associated with higher s-IGF1, whereas in patients no such association was found. No SNP was associated with IS, nor with stroke severity. After multivariate correction for presence of diabetes, smoking, and hypertension, the major allele of rs7136446 was associated with favorable functional outcome 24-months post-stroke (odds ratio 1.46; 95% CI 1.09–1.96).ConclusionVariation in rs7136446 of the IGF1 gene associates with post-stroke outcome in relatively young IS patients. Also, rs7136446 associates with s-IGF1 in controls but not in IS, which indicates that IS perturbs a normal genetic impact on s-IGF1 levels.

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Abstract P629: Genome-Wide Association Study of Individuals of Native Hawaiian Ancestry Reveals Unique Genetic Risk Factors for Stroke and Myocardial Infarction

Stroke ◽

10.1161/str.52.suppl_1.p629 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Stacy C Brown ◽

Cameron Both ◽

Julian N Acosta ◽

Natalia Szejko ◽

Victor Torres ◽

...

Keyword(s):

Myocardial Infarction ◽

Ischemic Stroke ◽

Association Study ◽

Genome Wide Association Study ◽

Native Hawaiian ◽

European Ancestry ◽

Intronic Region ◽

Genome Wide ◽

A Genome ◽

Risk Locus

Background: Several genetic susceptibility risk loci for ischemic stroke have been identified. However, the relative dearth of genetic data from populations of non-European ancestry has the potential to create disparities in access to genomics-based precision medicine strategies. Individuals of Native Hawaiian ancestry represent a particularly understudied group in stroke genomics research despite facing high rates of cerebrovascular disease. Hypothesis: Genetic variants associated with stroke differ between Native Hawaiians and previously studied groups of predominantly European ancestry. Methods: We conducted a genome-wide (GW) association study of stroke and myocardial infarction (MI) in an adult population of Native Hawaiian ancestry, using data from the Multiethnic Cohort study (MEC). Genetic information was ascertained via genome-wide array genotyping using the AB OpenArray and TaqMan platforms followed by imputation to 1000 Genomes reference panels. We pursued replication of variants that were GW significant (p<5x10 -8 ) or yielded suggestive associations (p<5x10 -7 ) in the prior stroke GW association study MEGASTROKE. Results: We identified 2,104 individuals (1,089 [51.8%] female) of Native Hawaiian ancestry, including 173 cases and 1,931 controls. We identified one novel susceptibility risk locus at a narrow intronic region located at chromosome q26.2 (top associated SNP 3:169096251, OR 2.48, 95%CI 1.81-3.41; p=1.93x10 -8 ), overlying the MECOM gene. We also identified 9 other suggestive risk loci at p<5x10 -7 . When replicating in MEGASTROKE, q26.2 did not have available counterpart variants to analyze, and 3 out of 9 suggestive signals were associated with ischemic stroke subtypes at p<0.05. Conclusions: We report the first GW association study of ischemic stroke and myocardial infarction in a Native Hawaiian population. We identified one susceptibility risk locus at q26.2, located in a narrow intronic region of MECOM, a gene that codes for a histone-lysine N-methyltransferase that has transcriptional regulation and oncoprotein functions. The lack of available replication data for this locus in the large MEGASTROKE collaboration emphasizes the importance of developing genomic resources across ancestral groups.

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Brain-derived neurotrophic factor in peripheral blood mononuclear cells and stroke outcome

Experimental Biology and Medicine ◽

10.1177/1535370218815612 ◽

2018 ◽

Vol 243 (15-16) ◽

pp. 1207-1211 ◽

Cited By ~ 1

Author(s):

Martin Pedard ◽

Céline Brenière ◽

Nicolas Pernet ◽

Catherine Vergely ◽

Yannick Béjot ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Peripheral Blood Mononuclear Cells ◽

Peripheral Blood ◽

Mononuclear Cells ◽

Stroke Outcome ◽

Stroke Patients ◽

Peripheral Blood Mononuclear ◽

Ischemic Brain ◽

Blood Mononuclear Cells

Stroke outcome is dependent on brain-derived neurotrophic factor (BDNF)-dependent neuroplasticity. As peripheral blood mononuclear cells (PBMC) contain BDNF, diapedesis of these cells might be followed by BDNF delivery to the ischemic brain. To test this hypothesis, we investigated the association between BDNF levels in PBMC and functional outcome in patients with ischemic stroke. BDNF was measured in PBMC that were isolated from ischemic stroke patients ( n = 40) just before (day 0) and after (days 1 and 3) fibrinolysis. Three months after stroke, patients were stratified using the modified Rankin Scale (mRS) according to the unfavorable (mRS scores 3–6) and favorable (mRS scores 0–2) functional outcome. We used univariate and multivariate logistic regressions to assess the relationship between BDNF levels in PBMC and functional outcome. BDNF levels in PBMC decreased from day 0 to day 3 in patients with unfavorable outcome, while they remained stable in patients with favorable outcome. Patients with favorable outcome exhibited at day 3 higher PBMC-BDNF levels than patients with unfavorable outcome and the levels were associated with good outcome (odd ratio: 12.0; 95% confidence interval, 1.4–106.2, P = 0.023). PBMC-BDNF levels remained a predictor of stroke outcome after adjusting from cardiovascular risk, interval between admission and fibrinolysis, stroke severity from hospital admission to discharge, lymphocytes count, neutrophils/lymphocytes ratio at admission. Favorable functional outcome in ischemic stroke patients that benefited from fibrinolysis was predicted by a high BDNF level in PBMC, suggesting that PBMC might serve as a cellular vector to deliver BDNF to the ischemic brain. Impact statement There are a great number of arguments suggesting that BDNF could be involved in stroke recovery dependent of neuroplasticity. Methods that can enhance BDNF levels in the ischemic brain could therefore have great clinical value. Peripheral blood mononuclear cells (PBMC) that contain BDNF and infiltrate early and sustainably the ischemic brain might be used as a cellular vector to deliver BDNF to the ischemic brain and consequently promote recovery. This work is important in this field to show if this BDNF derived from BDNF could exert a positive action on stroke recovery. Our main results showed that a high BDNF level at day 3 after hospital admission was associated with a 12.4 fold increase in favorable outcome after adjusting for still recognized prognostic markers. The new information in this field is this finding identifies PBMC as an attractive cellular vector to deliver BDNF to the ischemic brain.

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Predictors of the functional outcome after thrombolysis in an Egyptian patients’ sample

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00261-5 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

H. M. Eldeeb ◽

D. H. Elsalamawy ◽

A. M. Elabd ◽

H. S. Abdelraheem

Keyword(s):

Ischemic Stroke ◽

Hospital Stay ◽

Functional Outcome ◽

Arterial Occlusion ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Predicting Factors ◽

Egyptian Patients ◽

Cerebrovascular Stroke

Abstract Background About 6.2 million individuals worldwide and approximately 200 Egyptians/100,000 citizens have cerebrovascular stroke annually, and only less than 1% of stroke patients received intravenous (IV) thrombolysis in 2014. Outcome of the ischemic stroke after IV thrombolysis varies, and there is lack of data about the predicting factors that contributes to the outcome of ischemic strokes after IV thrombolysis in Egypt. Objective The aim of this work is to study the predictors of the functional outcome of ischemic cerebrovascular stroke after IV thrombolysis in Egyptian patients. Patients and methods This is a prospective study that includes acute ischemic stroke patients who received IV thrombolysis at the Alexandria University Hospital during the year from February 2017 to February 2018, and they were evaluated initially by Rapid Arterial Occlusion Evaluation (RACE) scale and followed-up serially for 6 months after thrombolysis using the National Institutes of Health Stroke Scale (NIHSS) and modified ranking score (mRS). Results Forty-five patients are included; 56% had favorable functional outcome (mRS 0–2) after 6 months, 68% had ≥ 4 points improvement in NIHSS after 6 months, and 13% had hemorrhagic conversion with 18% mortality rate. High initial RACE scale and long hospital stay are associated with poor functional outcome 6 months after thrombolysis. Conclusion Stroke severity demonstrated by high initial RACE and the duration of hospital stay are the two most significant predictors with an impact on the functional outcome of ischemic cerebrovascular stroke after thrombolysis.

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Abstract WP336: Patient Characteristics and in Hospital Complications Associated With High Cost Ischemic Stroke Admissions

Stroke ◽

10.1161/str.47.suppl_1.wp336 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Khawja A Siddiqui ◽

Xiu Liu ◽

Karen E Lynch ◽

Sadiqa B Mahmood ◽

Hui Zheng ◽

...

Keyword(s):

Ischemic Stroke ◽

Fasting Blood Glucose ◽

Patient Characteristics ◽

Artery Occlusion ◽

Stroke Severity ◽

Administrative Claims ◽

Comfort Care ◽

Logistic Regression Models ◽

Public Health Burden ◽

Targeted Interventions

Introduction: Stroke poses a major public health burden. We sought to determine the clinical and demographic variables associated with high cost among hospitalized ischemic stroke (IS) patients. Methods: Using our local Get with the Guidelines Stroke database, we identified 1,578 IS patients admitted from 2010- 2013 and linked them to administrative claims data (EPSI, inc). Patients in the highest cost quartile (n=394) were compared to all others (n=1184) using descriptive statistics and multilevel logistic regression models. All financial data are relative costs, reported as medians [IQR] multiplied by a constant. Results: The median relative cost in the top quartile was 4 times higher than that for all other patients. In univariate analyses, the groups differed substantially (Table 1). In multivariable models, high cost patients were more likely to have discharge ICD 9 codes of 433.11 or 434.91 (IS patients with carotid or cerebral artery occlusion), higher serum creatinine, fasting blood glucose and NIHSSS. They were more likely to receive IV or IA reperfusion, remain NPO during their stay or develop hospital acquired pneumonia, and less likely to transition to comfort care. The C statistic for a model with NIH stroke scale only performed well (c= 0.77) even when compared to a model with all variables present on admission (c= 0.83) or the fully adjusted model (c= 0.86). Conclusion: Many patient level demographic and clinical characteristics available on admission predict high cost, even after adjustment for stroke severity. Cost management opportunities may exist for targeted interventions, perhaps through geographic co-location or specialized stroke units.

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Abstract TP19: Charlson Comorbidity Index Predicts Mortality and Functional Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Stroke ◽

10.1161/str.47.suppl_1.tp19 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Daniela Samaniego ◽

Maria Hernandez-Perez ◽

Anna Planas ◽

Lorena Martin ◽

Laura Dorado ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Charlson Comorbidity Index ◽

Mechanical Thrombectomy ◽

Stroke Severity ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Arterial Revascularization ◽

Comorbidity Index ◽

High Comorbidity

Introduction: Despite mechanical thrombectomy has achieved a dramatic improvement on ischemic stroke prognosis, up to 50% of patients treated with this approach do not have good functional outcome. Besides age and baseline infarct core, comorbidity might play a role in stroke prognosis. We aim to study the capacity of Charlson comorbidity index (CCI) in predicting mortality and functional outcome in acute ischemic stroke patients who underwent mechanical thrombectomy. Methods: We studied 228 consecutive patients (59% male, mean age 65y) with acute anterior circulation arterial occlusion treated with stent retrievers between May 2009 and March 2015. Demographical data, stroke severity, ASPECTS score at baseline and medical conditions included in the CCI were collected and CCI score was calculated retrospectively. We considered low comorbidity if CCI score was <2 and high comorbidity if CCI score was ≥2. Complete arterial revascularization was defined as a TICI ≥2b on final angiographic run. Good functional outcome was defined as a modified Rankin score ≤2 at 90 days. Results: The CCI was 0 in 47% of patients, 1 in 23%, 2 in 15%, 3 in 10% and ≥4 in 5%. CCI of 2 or more was associated with poor functional outcome (70.6% vs 50%, p = 0.004) and mortality (33.8% vs. 11.7%, p <0.001) compared to patients with low CCI. In a logistic regression adjusted by stroke severity, age, ASPECTS score at baseline and arterial revascularization, high comorbidity remained as an independent predictor of poor outcome (OR 2.9; 95% CI 1.4-5.8) and mortality (OR 4.6, 95% CI 2.0-10.3). Conclusions: High comorbidity assessed by Charlson Comorbidity Index is associated with poor functional outcome and mortality in acute stroke patients treated with mechanical thrombectomy.

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Topographic correlation of infarct area on CT perfusion with functional outcome in acute ischemic stroke

Journal of Neurosurgery ◽

10.3171/2018.8.jns181095 ◽

2020 ◽

Vol 132 (1) ◽

pp. 33-41 ◽

Cited By ~ 3

Author(s):

Neil Haranhalli ◽

Nnenna Mbabuike ◽

Sanjeet S. Grewal ◽

Tasneem F. Hasan ◽

Michael G. Heckman ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Ct Perfusion ◽

Multivariable Analysis ◽

Reperfusion Therapy ◽

Infarct Core ◽

Anterior Circulation ◽

Logistic Regression Models ◽

Confounding Variables

OBJECTIVEThe role of CT perfusion (CTP) in the management of patients with acute ischemic stroke (AIS) remains a matter of debate. The primary aim of this study was to evaluate the correlation between the areas of infarction and penumbra on CTP scans and functional outcome in patients with AIS.METHODSThis was a retrospective review of 100 consecutively treated patients with acute anterior circulation ischemic stroke who underwent CT angiography (CTA) and CTP at admission between February 2011 and October 2014. On CTP, the volume of ischemic core and penumbra was measured using the Alberta Stroke Program Early CT Score (ASPECTS). CTA findings were also noted, including the site of occlusion and regional leptomeningeal collateral (rLMC) score. Functional outcome was defined by modified Rankin Scale (mRS) score obtained at discharge. Associations of CTP and CTA parameters with mRS scores at discharge were assessed using multivariable proportional odds logistic regression models.RESULTSThe median age was 67 years (range 19–95 years), and the median NIH Stroke Scale score was 16 (range 2–35). In a multivariable analysis adjusting for potential confounding variables, having an infarct on CTP scans in the following regions was associated with a worse mRS score at discharge: insula ribbon (p = 0.043), perisylvian fissure (p < 0.001), motor strip (p = 0.007), M2 (p < 0.001), and M5 (p = 0.023). A worse mRS score at discharge was more common in patients with a greater volume of infarct core (p = 0.024) and less common in patients with a greater rLMC score (p = 0.004).CONCLUSIONSThe results of this study provide evidence that several CTP parameters are independent predictors of functional outcome in patients with AIS and have potential to identify those patients most likely to benefit from reperfusion therapy in the treatment of AIS.

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