Background: Severe middle cerebral artery (MCA) stroke 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 outcomes. Methods: A consecutive, multi-institution, retrospective cohort of adult patients (≤70 years) was established from 2009-2011. 127 patients were first identified by NIHSS score ≥ 15 and then screened for initial infarct volume ≥ 60 mL3. Malignant edema was defined as the development of midline brain shift of ≥ 5 mm in the first 5 days. The only exclusion criterion was enrollment in any experimental trial. 6 patients were censored from secondary analysis given that therapeutic treatment was not pursued. A univariate and multivariate logistic regression analysis was performed to model and predict the factors related to outcomes. Significance was predefined at p≤0.05 (two-tailed). Results: 46 patients (29 female, 17 male; mean age 57.3±1.5) met study criteria. The mortality rate was 28% (n=13). Univariate predictors of mortality included infarct volume, intracranial pressure (ICP) crisis, and concurrent anterior cerebral artery (ACA) involvement. In a multivariate analysis, only concurrent ACA involvement was associated with mortality (OR 9.78, 95% CI 1.15, 82.8, p=0.04). Univariate predictors of tracheostomy were decompressive craniectomy (DC) and admission GCS score. In multivariate analysis, only admission GCS score was significant (OR 0.59, 95% CI 0.37, 0.94, p=0.03). Infarct volume, elevated peak serum sodium level, hyperosmolar therapy, and ICP crisis independently predicted the development of malignant edema, whereas only infarct volume remained significant in multivariate analysis (OR 1.02, 95% CI 1.00, 1.04, p=0.05). In the malignant edema subgroup (n=23, 58%), 4 died (17%), 7 underwent DC (30%), 7 underwent tracheostomy (30%), and 15 underwent gastrostomy (65%). Conclusion: Adverse outcomes after severe stroke are common. ACA involvement predicts mortality in severe MCA stroke. Knowledge of outcomes and their predictors is necessary for optimal care and future study.

中文翻译：

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摘要 WP140：并发大脑前动脉受累可预测重度大脑中动脉缺血性卒中的死亡率

背景：严重的大脑中动脉 (MCA) 卒中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结果。方法：从 2009 年到 2011 年建立了一个连续的、多机构的、回顾性的成年患者（≤70 岁）队列。127 名患者首先通过 NIHSS 评分 ≥ 15 进行鉴定，然后筛选初始梗塞体积 ≥ 60 mL3。恶性水肿被定义为在前 5 天内发生 ≥ 5 mm 的中线脑移位。唯一的排除标准是参加任何实验性试验。鉴于未进行治疗性治疗，6 名患者从二次分析中被审查。进行单变量和多变量逻辑回归分析以模拟和预测与结果相关的因素。显着性预定义为 p≤0.05（双尾）。结果：46 名患者（29 名女性，17 名男性；平均年龄 57.3±1.5）符合研究标准。死亡率为 28%（n=13）。死亡率的单变量预测因素包括梗死体积、颅内压 (ICP) 危象和并发大脑前动脉 (ACA) 受累。在多变量分析中，只有并发 ACA 受累与死亡率相关（OR 9.78, 95% CI 1.15, 82.8, p=0.04）。气管切开术的单变量预测因素是去骨瓣减压术 (DC) 和入院 GCS 评分。在多变量分析中，只有入院 GCS 评分显着（OR 0.59, 95% CI 0.37, 0.94, p=0.03）。梗塞体积，血清钠峰值水平升高、高渗治疗和 ICP 危象独立预测恶性水肿的发展，而在多变量分析中只有梗死体积仍然显着（OR 1.02, 95% CI 1.00, 1.04, p=0.05）。在恶性水肿亚组（n=23, 58%）中，4 人死亡（17%），7 人接受 DC（30%），7 人接受气管切开术（30%），15 人接受胃造口术（65%）。结论：严重卒中后的不良后果很常见。ACA 受累可预测严重 MCA 卒中的死亡率。了解结果及其预测因素对于最佳护理和未来研究是必要的。p = 0.05)。在恶性水肿亚组（n=23, 58%）中，4 人死亡（17%），7 人接受 DC（30%），7 人接受气管切开术（30%），15 人接受胃造口术（65%）。结论：严重卒中后的不良后果很常见。ACA 受累可预测严重 MCA 卒中的死亡率。了解结果及其预测因素对于最佳护理和未来研究是必要的。p = 0.05)。在恶性水肿亚组（n=23, 58%）中，4 人死亡（17%），7 人接受 DC（30%），7 人接受气管切开术（30%），15 人接受胃造口术（65%）。结论：严重卒中后的不良后果很常见。ACA 受累可预测严重 MCA 卒中的死亡率。了解结果及其预测因素对于最佳护理和未来研究是必要的。