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Value of infarct location in the prediction of functional outcome in patients with an anterior large vessel occlusion: results from the HERMES study

Lookup NU author(s): Professor Phil White



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021, The Author(s).Purpose: Follow-up infarct volume (FIV) is moderately associated with functional outcome. We hypothesized that accounting for infarct location would strengthen the association of FIV with functional outcome. Methods: We included 252 patients from the HERMES collaboration with follow-up diffusion weighted imaging. Patients received endovascular treatment combined with best medical management (n = 52%) versus best medical management alone (n = 48%). FIV was quantified in low, moderate and high modified Rankin Scale (mRS)-relevant regions. We used binary logistic regression to study the relation between the total, high, moderate or low mRS-relevant FIVs and favorable outcome (mRS < 2) after 90 days. The strength of association was evaluated using the c-statistic. Results: Small lesions only occupied high mRS-relevant brain regions. Lesions additionally occupied lower mRS-relevant brain regions if FIV expanded. Higher FIV was associated with a higher risk of unfavorable outcome, as were volumes of tissue with low, moderate and high mRS relevance. In multivariable modeling, only the volume of high mRS-relevant infarct was significantly associated with favorable outcome. The c-statistic was highest (0.76) for the models that included high mRS-relevant FIV or the combination of high, moderate and low mRS-relevant FIV but was not significantly different from the model that included only total FIV (0.75). Conclusion: This study confirms the association of FIV and unfavorable functional outcome but showed no strengthened association if lesion location was taken into account.

Publication metadata

Author(s): Tolhuisen ML, Ernst M, Boers AMM, Brown S, Beenen LFM, Guillemin F, Roos YBWEM, Saver JL, van Oostenbrugge R, Demchuck AM, van Zwam W, Jovin TG, Berkhemer OA, Muir KW, Bracard S, Campbell BCV, van der Lugt A, White P, Hill MD, Dippel DWJ, Mitchell PJ, Goyal M, Caan MWA, Marquering HA, Majoie CBLM

Publication type: Article

Publication status: Published

Journal: Neuroradiology

Year: 2022

Volume: 64

Pages: 521-530

Print publication date: 01/03/2022

Online publication date: 03/09/2021

Acceptance date: 01/08/2021

Date deposited: 22/09/2021

ISSN (print): 0028-3940

ISSN (electronic): 1432-1920

Publisher: Springer Science and Business Media Deutschland GmbH


DOI: 10.1007/s00234-021-02784-x


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