Background: and Purpose Stroke impairs cognition and movement. Although clinical severity and infarct volume can predict functional outcomes, variability in patient responses requires advanced structural and functional connectivity methods. Disconnection markers were tested to predict functional outcomes after acute ischemic stroke using diffusion tensor imaging. Methods: A probabilistic approach was used to quantify brain damage from white matter (WM) disconnections affecting cortical areas, using lesion masking on a tractography atlas and parcellation of gray matter into functional network nodes. Forty-three patients with acute ischemic stroke were grouped according to functional improvement (change in modified Rankin Scale score from 3–5 at discharge to 0–2 at 3-month follow-up). Significantly different structural disconnection measures between the groups were combined into a principal component and included in a logistic regression model to evaluate prediction accuracy. Fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity, and mean diffusivity of the disconnected WM tracts were analyzed. Results: Baseline structural disconnections in the mid-posterior and central corpus callosum predicted poor functional outcomes at 3 months, and increased somatomotor network (SMN) disconnection severity correlated with poor recovery. Age, National Institutes of Health Stroke Scale score, and structural disconnections significantly predicted functional outcomes in logistic regression models. The first principal component analysis of the dysconnectivity measures explained 88% of the total variance and improved prediction accuracy from 53.8% to 76.9%. Differences in FA and RD in the region of interest of the corpus callosum between outcome groups were statistically significant. Conclusions Predictive outcome markers from probabilistic structural disconnection mapping in acute stroke emphasize preserving interhemispheric corpus callosum and SMN connections.

Background: and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). Results:  Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). Conclusions  Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.

Background: and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). Results:  Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). Conclusions  Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.