Selection of anterior circulation acute stroke patients for mechanical thrombectomy

Acute ischemic stroke, Mechanical thrombectomy, Prognosis, Score Aged, 80 and over Male Prognosi Patient Selection Acute ischemic stroke Endovascular Procedures Score Middle Aged Prognosis Severity of Illness Index Acute ischemic stroke; Mechanical thrombectomy; Prognosis; Score Stroke Settore MED/26 - NEUROLOGIA 03 medical and health sciences 0302 clinical medicine 616 Humans Female Mechanical thrombectomy Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA Aged Thrombectomy
DOI: 10.1007/s00415-019-09454-2 Publication Date: 2019-07-03T13:02:53Z
ABSTRACT
The use of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) patients has increased with a parallel burden in procedural costs. We tested whether a new prognostic score could identify patients who are unlikely to benefit from MT.Patients from our endovascular stroke registry were assessed for imaging and clinical outcome measures and randomly divided into two subsets for derivation and validation. We created a new prognostic score based on clinical and radiological prognostic factors of poor outcome (mRS score ≥ 3) from the derivation cohort. Receiver operating characteristics curve analysis was used to assess the discrimination ability of the score. The score was then validated and compared to the MR PREDICTS score.The derivation/validation included 270/116 patients, respectively. After multivariate logistic regression analysis, pre stroke mRS, age, admission glycaemia, admission NIHSS, collateral flow, Clot Burden Score, Alberta Stroke Program Early CT score were used to create a new prognostic scoring system called Tor Vergata Stroke Score (TVSS). TVSS revealed a good prognostic accuracy with an AUC of 0.825 [95% CI 0.77-0.88] in the derivation cohort and an AUC of 0.820 [95% CI 0.74-0.90] in the validation cohort. When compared to the MR PREDICTS in the validation cohort, TVSS demonstrated higher prediction ability which was, however, not statistically significant (0.80 vs 0.78; P = 0.26).TVSS is a reliable tool for selection of AIS candidates for MT and optimization of transfer to comprehensive stroke centers.
SUPPLEMENTAL MATERIAL
Coming soon ....
REFERENCES (26)
CITATIONS (9)
EXTERNAL LINKS
PlumX Metrics
RECOMMENDATIONS
FAIR ASSESSMENT
Coming soon ....
JUPYTER LAB
Coming soon ....