Final infarct volume discriminates outcome in mild strokes

Abstract

Introduction

Knowledge of whether final infarct volume (FIV) predicts disability after mild stroke is limited. We sought to determine if FIV could differentiate good versus poor outcome after mild stroke.

Methods

We retrospectively identified 65 patients with mild stroke (National Institutes of Health Stroke Scale ≤5) in a multicenter registry of 2453 patients. We evaluated associations between FIV and clinical outcome and evaluated the optimal FIV threshold that discriminated favorable (modified Rankin scale (mRS) 0–1) versus poor (mRS 2–6) outcome.

Results

The FIV cut-point of 20 mL differentiated favorable and poor outcomes (area under curve (AUC) 0.73, 95% confidence interval: 0.58–0.88). Favorable outcome was observed in 37/45 (82%) with FIV < 20 mL, compared to 5/14 (36%) with FIV ≥ 20 mL (p < 0.01). FIV ≥ 20 mL remained strongly associated with poor outcome independent of age, gender, stroke severity, Alberta Stroke Program Early CT Score (ASPECTS), and proximal arterial occlusion.

Conclusion

In our small sample size, an FIV of 20 mL best differentiated between the likelihood of good versus poor outcome in patients with mild stroke. Further validation of infarct volume as a surrogate marker in mild stroke is warranted.