title: Burden of intracranial steno-occlusive lesions on initial computed tomography angiography predicts poor outcome in patients with acute stroke.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurology, University of California, San Francisco, CA, USA. alexlau@cuhk.edu.hk
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Lau
authors.forename: Ka-sing Lawrence
authors.initials: KS
authors.lastname: Wong
authors.forename: Michael
authors.initials: M
authors.lastname: Lev
authors.forename: Karen
authors.initials: K
authors.lastname: Furie
authors.forename: Wade
authors.initials: W
authors.lastname: Smith
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000000981:diagnostic imaging*