Internal border zone injury predicts the functional outcome of acute MCA stroke patients - 21/04/22

Doi : 10.1016/j.neurad.2022.03.012

R. Grange ^a, S. Grange ^a, N. Lutz ^a, P. Garnier ^c, D. Marinescu ^c, J. Varvat ^c, F.G. Barral ^a, C. Boutet ^a,^b, F.C. Schneider ^a,^b,^⁎
^a Radiology Department, CHU de Saint Etienne, Avenue Albert Raimond, 42270 Saint-Priest-En-Jarez, France
^b TAPE, EA7423, University of Lyon, Saint Etienne, France
^c Neurology Department, CHU de Saint Etienne, Avenue Albert Raimond, 42270 Saint-Priest-En-Jarez, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 21 April 2022
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Graphical abstract

Image, graphical abstract

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Highlights

•	Injury of the internal borderzone is an early marker of large-volume infarction, poor functional prognosis and IV thrombolysis resistance.
•	The internal borderzone injury is an independent marker of stroke severity; regardless of lesion volume.
•	Detection of IBZ may help to identify patients who will most likely benefit from aggressive reperfusion therapies.

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Abstract

Background and Purpose

Classification of deep (D), superficial (S) MCA territories and their junctional vascular area (the internal border zone, IBZ) can help to identify patients most likely to benefit from aggressive reperfusion therapy after stroke. We tested the prognostic value of an IBZ injury compared to DWI-ASPECTS and infarct volume.

Materials and Methods

DW lesions of 168 patients with acute (4.2±6.5 h) MCA strokes were retrospectively examined and manually delineated. Patients with haemorrhagic transformation or other neurological diseases were excluded. Clinical data were recorded within 24 h following symptom onset and 48 h for patients who benefited from reperfusion therapy. The occurrence of an IBZ injury was determined using a standardized stereotaxic atlas. Performance to predict a good outcome (mRS<3 at 3 months) was estimated through ROC curves for DWI-ASPECTS≤6, lesion volume≥100 mL and IBZ injury. Logistic regression models were performed to estimate independent outcomes for infarct volume and IBZ injury.

Results

Infarcts involving the IBZ were larger (94.9±98.8 mL vs. 30.2±31.3 mL), had higher NIHSS (13.8±7.2 vs. 7.2±5.7), more frequent MCA occlusions (64.9% vs. 28.3%), and worse outcomes (mRS 3.0±1.8 vs. 1.9±1.7), and were less responsive to IVtPA (34±47% vs. 55±48% of NIHSS improvement). The area under the ROC curves was comparable between the occurrence of IBZ injury (0.651), ASPECTS≤6 (0.657) and volume≥100 mL (0.629). Logistic regression analyses showed an independent effect of an IBZ injury, especially for superficial MCA strokes and for patients who benefited from reperfusion therapy.