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J Stroke. 2014 Jan;16(1):36-43. English. Original Article.
Kang J , Park TH , Lee KB , Park JM , Ko Y , Lee SJ , Hong KS , Cho YJ , Lee JS , Lee J , Lee BC , Yu KH , Kim DH , Cha JK , Lee J , Jang MS , Han MK , Bae HJ .
Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
Department of Neurology, Seoul Medical Center, Seoul, Korea.
Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea.
Department of Neurology, Ilsan Paik Hospital, Inje University, Koyang, Korea.
Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea.
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
Department of Neurology, Hallym University College of Medicine, Anyang, Korea.
Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
Department of Neurology, Yeungnam University Medical Center, Daegu, Korea.
Department of Neurology, Samsung Changwon Medical Center, Sungkyunkwan University School of Medicine, Changwon, Korea.

BACKGROUND AND PURPOSE: Symptomatic steno-occlusion (SYSO) in acute ischemic stroke has a significant impact on treatment options and prognosis. However, the prevalence, distribution, clinical characteristics, and outcome of SYSO are not well known. METHODS: We retrospectively identified 3,451 patients hospitalized because of ischemic stroke within 24 hours of symptom onset at 9 stroke centers in South Korea. Patients who did not undergo magnetic resonance imaging were excluded. SYSO was defined as stenosis or occlusion of cerebral arteries with relevant ischemic lesions in the corresponding arterial territory. The number, location, and severity of SYSOs and their effects on functional outcome were analyzed. RESULTS: In total, 1,929 of 3,057 subjects (63.1%) had SYSO. The most frequently affected vessels were the middle cerebral artery (34.6%), extracranial internal carotid artery (14%), vertebral artery (12.4%), and basilar artery (8.7%). SYSO predicted poor outcome on the modified Rankin Scale 3-6 (odds ratio, 1.77; 95% confidence interval, 1.46-2.15) with adjustments. Involvement of 2 or more vessels was observed in 30.6% of patients with SYSO and independently increased the risk of poor outcome (odds ratio, 2.76; 95% confidence interval, 2.12-3.59). The severity of SYSO was associated with outcome and showed a significant dose-response trend (P<0.001). The effect of SYSO on outcome did not significantly differ by individual arterial location (P for contrast=0.21). CONCLUSIONS: Approximately 60% of patients with acute ischemic stroke had SYSO, and the severity and number were inversely correlated with outcome. The results suggest that SYSO could predict stroke outcome.

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