Dr. Stefanie Balk (Erlangen / DE), Dr. Teresa Siller (Bern / CH), Dr. Maximilian Sprügel (Erlangen / DE), Dr. Stefan Hock (Erlangen / DE), Daniel Heinze (Erlangen / DE), Prof. Dr. Tobias Engelhorn (Erlangen / DE), PD Dr. Bernd Kallmünzer (Erlangen / DE), Prof. Dr. Stefan Schwab (Erlangen / DE), PD Dr. Joji Kuramatsu (Erlangen / DE), PD Dr. Jochen Sembill (Erlangen / DE)
Abstract-Text (inkl. Referenzen und Bildunterschriften)
Background
Although more severe functional impairment has generally been reported after hemorrhagic stroke compared with ischemic stroke, it is unclear whether the actual brain lesion results in different degrees of sustained brain injury. In particular, a comparison of the influence of both types of stroke by lesion size and location on functional outcome has not been adequately investigated.
Methods
We investigated data from two cohort studies conducted at the university hospital Erlangen, Germany, i.e. the longitudinal cohort Study on intracerebral hemorrhage (ICH) care (2006-2015) and a retrospective institutional registry including patients with acute ischemic stroke (AIS) who received IV thrombolysis or thrombectomy (2011-2015). We included only patients with hemorrhagic or ischemic stroke in the middle cerebral artery territory and excluded patients with multiple stroke lesions, ICH secondary to ischemic stroke, ICH with intraventricular extension or hematoma expansion, or patients who required brain surgery. Among included patients, we performed propensity score matching to obtain evenly balanced cohorts with respect to demographic characteristics and specific volumetrically assessed stroke lesion size and affected location according to Alberta Stroke Programme Early CT Score (ASPECTS) regions. We compared functional outcomes between matched cohorts and between specific subgroups using ordinal shift analyses of the modified Rankin Scale (mRS) at 3 months.
Results
We included 131 patients with ICH and 173 patients with AIS. After controlling for unbalanced distribution of sex, premorbid functional dependence, volume and specific location of stroke lesion, we compared the functional outcomes of 194 propensity-matched patients, 97 with ICH and 97 with AIS. We observed a shift in the distribution of the mRS towards better functional outcomes in favor of AIS over ICH (generalized odds ratio [OR] 1.69, 95% confidence interval [CI] 1.02-2.79), p=0.04). The results were more pronounced in the subgroups of younger patients (age
Conclusion
For the same lesion size and location, patients with hemorrhagic stroke have a worse 3-month functional outcome than patients with ischemic stroke. This seems to be particularly the case in younger patients with smaller stroke lesions.