Akademik Veri Yönetim Sistemi
STROKE, cilt.57, sa.5, ss.1196-1207, 2026 (SCI-Expanded, Scopus)
BACKGROUND: Acute ischemic stroke affecting the middle cerebral artery (MCA) remains a major global cause of death and disability. However, it remains unclear whether the laterality of MCA strokes independently influences inpatient outcomes. Despite the fact that the National Institutes of Health Stroke Scale score is heavily weighted toward left-sided acute ischemic stroke, we hypothesize that right MCA strokes (R-MCASs) are associated with worse inpatient outcomes because they would require more severe deficits to amount to a comparable National Institutes of Health Stroke Scale score for a left MCA stroke. METHODS: A retrospective cross-sectional analysis was conducted using data from the National Inpatient Sample between 2015 and 2022. This nationally representative sample included adult patients (aged >= 18 years) in the United States hospitalized primarily for MCA strokes and with reported National Institutes of Health Stroke Scale scores. Patients were stratified into R-MCAS and left MCA stroke. Outcomes included odds of inpatient mortality, routine discharge, complications, and receipt of reperfusion therapy. Propensity score-based inverse probability of treatment weighting is adjusted for confounding factors. Multivariable logistic regression evaluated adjusted odds ratios (aORs) and 95% CIs for all outcomes. RESULTS: Among 489 360 acute ischemic stroke hospitalizations, 263 495 (53.8%) were left MCA stroke, and 225 865 (46.2%) were R-MCAS. Following inverse probability of treatment weighting, R-MCASs were significantly more likely to receive endovascular thrombectomy (aOR, 1.26 [95% CI, 1.22-1.30]; P<0.001) and less likely to receive intravascular thrombolysis (aOR, 0.965 [95% CI, 0.937-0.994]; P=0.018). R-MCAS was associated with significantly increased odds of cerebral edema/herniation (aOR, 1.53 [95% CI, 1.47-1.59]; P<0.001), hemorrhagic transformation (aOR, 1.25 [95% CI, 1.20-1.30]; P<0.001), and sepsis (aOR, 1.35 [95% CI, 1.25-1.46]; P<0.001). Left MCA stroke was associated with a higher likelihood of coma (aOR, 0.920 [95% CI, 0.889-0.952]; P<0.001). R-MCAS had significantly higher odds of inpatient mortality (aOR, 1.19 [95% CI, 1.12-1.26]; P<0.001) and lower odds of routine discharge (aOR, 0.786 [95% CI, 0.760-0.812]; P<0.001). CONCLUSIONS: Patients with R-MCAS were more likely to receive endovascular thrombectomy and less likely to receive intravascular thrombolysis. R-MCASs were also associated with worse discharge disposition and increased likelihood of inpatient mortality. The National Institutes of Health Stroke Scale bias toward assessment and valuation of patients' language abilities may place patients with R-MCAS at increased risk of adverse poststroke outcomes and complications. Recognition of the subtle signs of nondominant hemisphere strokes may lead to more rapid detection, effective treatment, and improved outcomes.