@article{3121398,
    title = "Lateralization of Insular Ischemic Stroke is Not Associated With Any Stroke Clinical Outcomes: The Athens Stroke Registry",
    author = "Vassilopoulou, S. and Korompoki, E. and Tountopoulou, A. and Mitsikostas, D.D. and Manios, E. and Georgiopoulos, G. and Ntaios, G. and Milionis, H. and Fontara, S. and Vemmos, K.",
    journal = "Journal of Stroke and Cerebrovascular Diseases",
    year = "2020",
    volume = "29",
    number = "2",
    publisher = "W.B. Saunders",
    issn = "1052-3057",
    doi = "10.1016/j.jstrokecerebrovasdis.2019.104529",
    keywords = "aged;  brain circulation;  brain cortex;  brain ischemia;  cause of death;  cerebrovascular accident;  comparative study;  disease exacerbation;  female;  Greece;  hemispheric dominance;  human;  male;  middle aged;  mortality;  pathophysiology;  prognosis;  prospective study;  recurrent disease;  register;  risk assessment;  risk factor;  time factor;  vascularization;  very elderly, Aged;  Aged, 80 and over;  Brain Ischemia;  Cause of Death;  Cerebral Cortex;  Cerebrovascular Circulation;  Disease Progression;  Female;  Functional Laterality;  Greece;  Humans;  Male;  Middle Aged;  Prognosis;  Prospective Studies;  Recurrence;  Registries;  Risk Assessment;  Risk Factors;  Stroke;  Time Factors",
    abstract = "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. © 2019 Elsevier Inc."
}