Background: Prognosis after AChA stroke has been associated with NIHSS and lesion size, but there is limited data on the prevalence of perfusion abnormalities. The goal of this study was to determine the association of perfusion abnormalities and outcome in patients with AChA stroke.
Methods: The study population was derived from ischemic stroke patients admitted to two primary stroke centers between 07/2000 and 07/2014. Patients received an MRI within 24 hours of symptom onset. Patients with ischemic stroke restricted to the AChA territory were included. A perfusion abnormality (MTT or TTP) which corresponded to DWI were categorized by visual assessment. Patients were excluded if DWI or PWI studies were incomplete or uninterpretable (N=58). Lesion size was measured as the largest diameter on DWI. Demographics, stroke risk factors, and discharge status was collected on all patients. Group comparisons were performed among patients with and without perfusion abnormalities with appropriate statistical tests as indicated.
Results: Overall, 121 patients were included in the study; mean age was 66 (± 15.3 yrs.), 56% were male, and 41% white. Rates of stroke risk factors: hypertension (86%), hyperlipidemia (49%), diabetes (33%), prior stroke (22%) and atrial fibrillation (12%). The median (IQR) admit NIHSS was 5 (2-8), 25% received IV tPA, and 45% were discharged to home. Perfusion abnormalities were identified in 62% of patients. Lesion size (median, IQR) was greater among patients with a perfusion abnormality (1.63; 1.24-2.04) vs. those without (1.26; 0.99-1.6, p<0.005). Patients with a perfusion abnormality were less likely to be discharged to home than those without (35% vs. 63%, p=0.003). Univariate predictors of discharge to a rehabilitation or subacute facility included age (p<0.05), NIHSS on admission (p<0.05), and a perfusion abnormality (p<0.05).
Conclusion: Two thirds of patients with AChA stroke have a perfusion abnormality. Patients with a perfusion abnormality have a higher NIHSS on admission and are less likely to be discharged home than patients without perfusion abnormalities.