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Neurocritical Care
Published in: Neurocritical Care 1/2014

01-08-2014 | ORIGINAL ARTICLE

Outcomes in Severe Middle Cerebral Artery Ischemic Stroke

Authors: Brian P. Walcott, Jennifer C. Miller, Churl-Su Kwon, Sameer A. Sheth, Marc Hiller, Carolyn A. Cronin, Lee H. Schwamm, J. Marc Simard, Kristopher T. Kahle, W. Taylor Kimberly, Kevin N. Sheth

Published in: Neurocritical Care | Issue 1/2014

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Abstract

Background

Severe middle cerebral artery stroke (MCA) is associated with a high rate of morbidity and mortality. We assessed the hypothesis that patient-specific variables may be associated with outcomes. We also sought to describe under-recognized patient-centered outcomes.

Methods

A consecutive, multi-institution, retrospective cohort of adult patients (≤70 years) was established from 2009 to 2011. We included patients with NIHSS score ≥15 and infarct volume ≥60 mL measured within 48 h of symptom onset. Malignant edema was defined as the development of midline brain shift of ≥5 mm in the first 5 days. Exclusion criterion was enrollment in any experimental trial. A univariate and multivariate logistic regression analysis was performed to model and predict the factors related to outcomes.

Results

46 patients (29 female, 17 male; mean age 57.3 ± 1.5 years) met study criteria. The mortality rate was 28 % (n = 13). In a multivariate analysis, only concurrent anterior cerebral artery (ACA) involvement was associated with mortality (OR 9.78, 95 % CI 1.15, 82.8, p = 0.04). In the malignant edema subgroup (n = 23, 58 %), 4 died (17 %), 7 underwent decompressive craniectomy (30 %), 7 underwent tracheostomy (30 %), and 15 underwent gastrostomy (65 %).

Conclusions

Adverse outcomes after severe stroke are common. Concurrent ACA involvement predicts mortality in severe MCA stroke. It is useful to understand the incidence of life-sustaining procedures, such as tracheostomy and gastrostomy, as well as factors that contribute to their necessity.
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Metadata
Title
Outcomes in Severe Middle Cerebral Artery Ischemic Stroke
Authors
Brian P. Walcott
Jennifer C. Miller
Churl-Su Kwon
Sameer A. Sheth
Marc Hiller
Carolyn A. Cronin
Lee H. Schwamm
J. Marc Simard
Kristopher T. Kahle
W. Taylor Kimberly
Kevin N. Sheth
Publication date
01-08-2014
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2014
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-013-9838-x

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