Subacute lesion volume as a potential prognostic biomarker for acute ischemic stroke after intravenous thrombolysis

Background: The aim of this study was to identify whether subacute diffusion -weighted imaging (DWI) lesion volume could predict long-term outcome in patients who had undergone intravenous thrombolysis. Method: Patients underwent DWI at baseline and 7 days after thrombolysis. Outcomes included complete independence (modified Rankin scale [mRS] score 0 to 1), unfavorable outcome (mRS score 4 to 6) at 90 days, and mortality within 90 days. Multivariate logistic regression analysis was used to identify outcome predictors. Results: Of 164 patients, 72 patients (43%) achieved complete independence. Poor outcomes were observed in 45 patients (27%) with an unfavorable outcome and 10 patients (6%) who died. Subacute DWI lesion volume was 3.4 mL (interquartile range, 1.1-11.6) in patients with complete independence, 90.1 mL (23.8-180.2) in patients with unfavorable outcome and 155.5 mL (78.4-377.5) in patients who died. In multivariate logistic regression analysis, subacute DWI lesion volume was an independent predictor of complete independence (odds ratio [OR], 0.939; 95% confidence interval [CI], 0.914-0.965; p < 0.001), unfavorable outcome (OR, 1.023; 95% CI, 1.014-1.033; p < 0.001), and mortality (OR, 1.016; 95% Cl, 1.005-1.028; p = 0.005). Conclusion: Subacute DWI lesion volume is a critical determinant of 90-day functional outcome and mortality after thrombolysis. (C) 2016 Elsevier B.V. All rights reserved.