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.

中文翻译：

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严重大脑中动脉缺血性卒中的结果。


背景技术严重大脑中动脉卒中（MCA）与高发病率和死亡率相关。我们评估了患者特定变量可能与结果相关的假设。我们还试图描述未被充分认识的以患者为中心的结果。方法从 2009 年至 2011 年建立了一个连续、多机构、回顾性的成年患者（≤70 岁）队列。我们纳入了 NIHSS 评分≥15 且在症状出现 48 小时内测量的梗死体积≥60 mL 的患者。恶性水肿定义为前5天内脑中线移位≥5毫米。排除标准是参加任何实验性试验。进行单变量和多变量逻辑回归分析来建模和预测与结果相关的因素。结果 46 名患者（29 名女性，17 名男性；平均年龄 57.3 ± 1.5 岁）符合研究标准。死亡率为 28% (n = 13)。在多变量分析中，仅并发大脑前动脉 (ACA) 受累与死亡率相关（OR 9.78，95% CI 1.15、82.8，p = 0.04）。在恶性水肿亚组（n = 23，58%）中，4 例死亡（17%），7 例接受去骨瓣减压术（30%），7 例接受气管造口术（30%），15 例接受胃造口术（65%）。结论 严重中风后的不良后果很常见。同时 ACA 受累可预测严重 MCA 卒中的死亡率。了解气管造口术和胃造口术等维持生命手术的发生率以及导致其必要性的因素是有用的。