Objectives The relationship between stroke topography (ie, the regions damaged by the infarct) and functional outcome can aid clinicians in their decision-making at the acute and later stages. However, the side (left or right) of the stroke may also influence the identification of clinically relevant regions. We sought to determine which brain regions are associated with good functional outcome at 3 months in patients with left-sided and right-sided stroke treated by endovascular treatment using the diffusion-weighted imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS).
Methods Patients with ischaemic stroke (n = 405) were included from the ASTER trial and Pitié-Salpêtrière registry. Blinded readers rated ASPECTS on day 1 DWI. Stepwise logistic regression analyses were performed to identify the regions related to 3-month outcome in left (n = 190) and right (n = 215) sided strokes with the modified Rankin scale (0–2) as a binary independent variable and with the 10 regions-of-interest of the DWI-ASPECTS as independent variables.
Results Median National Institute of Health Stroke Scale (NIHSS) at baseline was 17 (IQR: 12–20), median age was 70 years (IQR: 58–80) and median day-one NIHSS 9 (IQR: 4–18). Not all brain regions have the same weight in predicting good outcome at 3 months; moreover, these regions depend on the affected hemisphere. In left-sided strokes, the multivariate analysis revealed that preservation of the caudate nucleus, the internal capsule and the cortical M5 region were independent predictors of good outcome. In right-sided strokes, the cortical M3 and M6 regions were found to be clinically relevant.
Conclusion Cortical non-motors areas related to outcome differed between left-sided and right-sided strokes. This difference might reflect the specialisation of the dominant and non-dominant hemispheres for language and attention, respectively. These results may influence decision-making at the acute and later stages.
Trial registration number NCT02523261.
- acute treatment
- magnetic resonance imaging
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Collaborators ASTER Trial Investigators: Rothschild Foundation: Michel Piotin, Raphael Blanc, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Mikael Mazighi, Robert Fahed, Jean-Philippe Desilles; Foch Hospital: Bertrand Lapergue, Georges Rodesch, Arturo Consoli, Oguzhan Coskun, Federico Di Maria, Frédéric Bourdain, Jean Pierre Decroix, Adrien Wang, Maya Tchikviladze, Serge Evrard; Hospices Civils de Lyon: Francis Turjman, Benjamin Gory, Paul Emile Labeyrie, Roberto Riva; Limoges University Hospital: Charbel Mounayer, Suzanna Saleme; Montpellier University Hospital Center: Vincent Costalat, Alain Bonafé, Omer Eker, Grégory Gascou, Cyril Dargazanli; Nancy University Hospital Center: Serge Bracard, Romain Tonnelet,Anne Laure Derelle, René Anxionnat; Nantes University Hospital Center: Hubert Desal, Romain Bourcier, B Daumas-Duport; Bordeaux University Hospital Center: Jérome Berge, Xavier Barreau, Gauthier Margnat; Department of Biostatistics,University of Lille: Lynda Djemmane, Julien Labreuche, Alain Duhamel. Pitié-Salpêtrière registry: Yves Samson, Sophie Crozier, Sandrine Deltour, Anne Leger, Flore Baronnet, Charlotte Rosso, Fredéric Clarencon, Nader Sourour, Ehmad Shotar, Christine Pires.
Contribution CR: study design data analysis drafting of manuscript. BL and MP: study design, data collection, manuscript revision. RB, JL, YS, SL, BG, GM, MM, AC, SS, VC, SB and HD: data collection, manuscript revision. JL: data analysis, manuscript revision.
Funding The Pitié-Salpêtrière registry was supported by the French Ministry of Health grant EVALUSINV PHRC AOM 03 008. The research leading to these results has received funding from ‘Investissements d’avenir’ ANR-10-IAIHU-06. The ASTER trial was sponsored by the Fondation Ophtalmologique Adolphe de Rothschild. An unrestricted research grant was provided for the ASTER trial by Penumbra, Alameda, California. No grant was provided for this analysis and this study.
Competing interests None declared.
Patient consent Not required.