Outcome Predictor Differences in Infratentorial and Supratentorial Ischemic Stroke

TL;DR

This study finds that factors predicting stroke outcomes differ between infratentorial and supratentorial stroke patients.

Contribution

The study identifies distinct outcome-relevant factors for infratentorial and supratentorial ischemic stroke.

Findings

Infratentorial stroke patients had less severe neurological deficits and lower rates of certain conditions compared to supratentorial patients.

A poor outcome in infratentorial strokes was associated with atrial fibrillation and lower kidney function.

For supratentorial strokes, the severity of neurological deficit was the strongest predictor of poor outcomes.

Abstract

Acute ischemic stroke outcomes depend on various factors. We investigated whether the outcome-relevant factor (ORF) profiles differ between different vascular territories and different therapeutic strategies. In this retrospective study, we analyzed 410 comprehensive stroke center patients [median age of 70 years (IQR 57–80), 125 women (30%)] by analyzing five groups: all patients, patients with infratentorial infarctions only (n = 80), all patients with supratentorial infarctions (n = 330), patients with supratentorial infarctions without (n = 269), and with mechanical thrombectomy (n = 61). Outcomes were classified with the modified Rankin scale as ≤2 (good) or >2 (poor) after three months. The patient group with infratentorial strokes was compared to the group of patients with supratentorial strokes using the Kruskal–Wallis test or chi-squared statistics. Within each of the five stroke groups, univariate logistic regression analysis was used to identify the ORF of a poor outcome; if more than one ORF was identified, all identified factors were included in one multinomial logistic regression analysis model. Compared to the patients with supratentorial strokes, the patients with infratentorial stroke exhibited a less severe neurological deficit at entry and lower rates of ischemic heart disease, thrombolytic intervention, and cardio-embolism but a higher rate of large vessel disease. After multinomial logistic regression analysis, a poor outcome in the infratentorial group was associated with atrial fibrillation [odds ratio (OR) 13.73 (95% confidence interval 1.05–181.89), p = 0.04], estimated glomerular filtration rate [OR 0.96 (0.91–0.99)], p = 0.02], and marginally with diabetes mellitus [OR 7.69 (0.96–62.63), p = 0.05]. In all three supratentorial stroke groups, the neurological deficit as scored by the National Institute of Health Stroke Scale [OR 1.32 (1.22–1.44), p < 0.0001] was predominantly associated with a poor outcome, accompanied by age only in the group of all supratentorial strokes [OR 1.04 (1.01–1.08), p = 0.01]. In this cohort of mild to moderate stroke patients, the ORFs differed between the supra- and infratentorial stroke populations.

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