Predictors of functional outcome at discharge in anterior large vessel occlusion stroke

Lilliana Ma. Giraldo-Tapias, Departamento de Medicina, Grupo de Investigación en Ciencias de la Vida y la Salud, Universidad CES, Medellín; Departamento de Neurología, Neurología Vascular y Hemodinámica Cerebral, Fundación Instituto Neurológico de Colombia, Medellín; Colombia
Rafael Bernal-Cobo, Departamento de Neurología, Clínica Comfamiliar, Pereira, Colombia
Ángela Ma. Restrepo-Gil, Departamento de Neurología, Neurología Vascular y Hemodinámica Cerebral, Fundación Instituto Neurológico de Colombia, Medellín, Colombia
Tatiana Gómez-Escobar, Departamento de Neurología, Neurología Vascular y Hemodinámica Cerebral, Fundación Instituto Neurológico de Colombia, Medellín, Colombia
Esteban Agudelo-Quintero, Departamento de Neurología, Neurología Vascular y Hemodinámica Cerebral, Fundación Instituto Neurológico de Colombia, Medellín. Colombia
Lina Ma. Salazar-Peláez, Departamento de Medicina, Grupo de Investigación en Ciencias de la Vida y la Salud, Universidad CES, Medellín, Colombia

Background: Several patients with anterior large vessel ischemic stroke do not achieve functional independence despite reperfusion therapy. Objective: To determine the clinical course, neuroimaging biomarkers, and functional outcome at hospital discharge. Methods: Observational retrospective study including seventy-five patients with anterior large vessel stroke admitted to the Fundación Instituto Neurológico de Colombia (2015-2018). Functional outcome at discharge was categorized as favorable (modified Rankin scale [mRS] 0-2) or unfavorable (mRS 3-6). Results: At hospital discharge, 32% of patients achieved a favorable outcome. In multivariate analysis, older age (adjusted odds ratio [aOR] 1.06; 95% confidence interval [CI] 1.01-1.11; p = 0.01) and higher baseline National Institutes of Health Stroke Scale (NIHSS) (aOR 1.24; 95% CI 1.07-1.44; p = 0.004) were independently associated with adverse outcomes. In contrast, intravenous thrombolysis (aOR 4.2; CI 95% 0.96-18.9; p = 0.05) was associated with a lower risk of poor outcome. Conclusions: Advanced age and greater clinical (NIHSS) severity at admission predict unfavorable functional outcome, while thrombolytic therapy showed a protective effect in patients with anterior large vessel stroke.

Keywords: Core. Imaging biomarker. Large vessel. Magnetic resonance imaging. Reperfusion.