Burden of Intracranial Steno-Occlusive Lesions on Initial Computed Tomography Angiography Predicts Poor Outcome in Patients With Acute Stroke

Abstract

Background and Purpose— Computed tomography angiography is an accurate noninvasive method to diagnose intracranial steno-occlusive disease (ICAD) at initial presentation for stroke. We aimed to identify features of computed tomography angiography associated with unfavorable outcome. Methods— We identified patients with ICAD in the Screening Technology and Outcomes Project in Stroke Study, a prospective imaging-based study of stroke outcomes, in consecutive patients with ischemic stroke or transient ischemic attack (TIA) presenting to 2 academic medical centers. All patients underwent computed tomography angiography, which were graded by 2 neuroradiologists independently. Univariate and multiple logistic regression was used to evaluate predictors of favorable outcome at 6 months, defined as a modified Rankin Scale ≤2. Results— Among 539 patients that met study entry criteria, ICAD was identified in 212 patients (39%); 116 patients (22%) had concurrent extraintracranial lesions, and 66 patients (12%) had multiple sites of ICAD. Patients with ICAD had more severe stroke (median National Institutes of Health Stroke Scale, 9 versus 3; P <0.001), worse outcomes at 6 months (modified Rankin Scale, 0–2; 57% versus 73%; P <0.001), and higher mortality (18% versus 8%; P =0.001). In the multivariate model, age (odds ratio [OR], 0.75 per decade; 95% confidence interval [CI], 0.65–0.87), female sex (OR, 0.49; 95% CI, 0.32–0.73), multiple sites of ICAD (OR, 0.53; 95% CI, 0.29–0.97), complete occlusion (OR, 0.42; 95% CI, 0.25–0.72), and concurrent extraintracranial lesions (OR, 0.51; 95% CI, 0.31–0.84) negatively predicted favorable outcome. Conclusions— Findings of multiple sites of ICAD from computed tomography angiography, concurrent extraintracranial lesions, and complete occlusion are independent predictors of unfavorable outcome at 6 months.