Lateralization of Insular Ischemic Stroke is Not Associated With Any Stroke Clinical Outcomes: The Athens Stroke Registry

• Published in: Journal of stroke and cerebrovascular diseases 2020-02, Vol.29 (2), p.104529-104529, Article 104529
• Main Authors: Vassilopoulou, Sophia, Korompoki, Eleni, Tountopoulou, Argyro, Mitsikostas, Dimos D., Manios, Efstathios, Georgiopoulos, Georgios, Ntaios, George, Milionis, Haralampos, Fontara, Sophia, Vemmos, Konstantinos
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Brain Ischemia - diagnosis; Brain Ischemia - mortality; Brain Ischemia - physiopathology; Brain Ischemia - therapy; cardiovascular events; Cause of Death; Cerebral Cortex - blood supply; Cerebrovascular Circulation; Disease Progression; Female; Functional Laterality; Greece; Humans; Insular stroke; lateralization; Male; Middle Aged; mortality; Prognosis; Prospective Studies; Recurrence; Registries; Risk Assessment; Risk Factors; Stroke - diagnosis; Stroke - mortality; Stroke - physiopathology; Stroke - therapy; stroke recurrence; Time Factors
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2019.104529

Background: Controversial evidence suggests that right insular stroke may be associated with worse outcomes compared to the left insular ischemic lesion. Objectives: We investigated whether lateralization of insular stroke is associated with early and late outcome in terms of in-hospital complications, stroke recurrence, cardiovascular events, and death. Methods: Data were prospectively collected from the Athens Stroke Registry. Insular cortex involvement was identified based on brain CT scans or MRI images. Patients were followed up prospectively at 1, 3, 6 months after hospital discharge and yearly thereafter up to 5-years or until death. The assessed outcomes were in-hospital complications, functional outcome assessed by the modified Rankin Scale, stroke recurrence, cardiovascular events, and death. Cox-regression analysis was performed to estimate the cumulative probability of each outcome according to the lateralization of insular strokes. Results: Among the 1212 patients, 650 had left insular stroke involvement and 562 had right. New onset of in-hospital atrial fibrillation was similar between right and left insular strokes (11.6% versus 12.9%, P = .484). During the 5-year follow-up sudden death occurred in 21 (3.7%) patients with right insular compared to 30 (4.6%) with left insular stroke (P = .476). There was no difference between left and right insular strokes regarding mortality (adjusted odds ratio [OR]: .92, 95% confidence interval [CI]: .80-1.06), stroke recurrence (4.3% versus 4.9%; adjusted OR: .81 95% CI: .58-1.13), cardiovascular events, and sudden death (adjusted OR: .99, 95% CI: .76-1.29) and on death and dependency (adjusted OR: .88, 95% CI: .75-1.02) during a 5-year follow up. Conclusions: Lateralization of insular ischemic stroke involvement is not associated with stroke outcomes.