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  • A Novel Prediction Score for Good Clinical Outcome After iv-rtPA or Intra-arterial Therapy in Acute Ischemic Stroke

    Final Number:

    Hidehisa Nishi; Nobutake Sadamasa; Ichiro Nakahara; Shoji Matsumoto; Ryota Ishibashi; Masanori Gomi; Makoto Saka; Takuya Okata; Haruka Miyata; Junpei Kouge; Sadayoshi Watanabe; Izumi Nagata

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: There are multiple outcome prediction scores after intravenous thrombolysis or endovascular treatment in acute ischemic stroke. We sought to derive a novel outcome prediction score including early ischemic change on diffusion-weighted image (DWI), which is reported to be one of the determinants of stroke outcomes in anterior circulation.

    Methods: We retrospectively analyzed patients receiving tissue plasminogen activator or endovascular recanalization therapy in our institution between 2006 and 2014. Clinical and radiographic variables were included in multivariate regression analysis. Independent predictors of good outcome (modified Rankin scale?2 at 90 days) were combined to establish prediction score. The new prediction score was assigned as follows and ranged from 0 to 6: age (<60=0, 60-80=1, >80=2), baseline NIHSS (<10=0, 10-20=1, >20=2), the DWI-ASPECTS (0-4=2, 5-7=1, 8-11=0). The new prediction score were compared with THRIVE score and SPAN-100 by Receiver Operating Characteristic (ROC) curve analysis to validate the accuracy in discriminating patient outcome.

    Results: A total of 110 patients were included in the analysis. Independent predictors of good outcome were age, baseline National Institute Health Stroke Scale (NIHSS), and Alberta Stroke Programme Early CT Score (ASPECTS) on DWI. These predictors were included in score variables. Our new prediction score showed relatively good discrimination (C statistic 0.75) and was superior to the THRIVE score (C statistic 0.65) and SPAN score (C statistic 0.50).

    Conclusions: Our prediction score may have more accuracy in discriminating patients’ good clinical outcome than THRIVE score and SPAN-100. There are multiple prediction scores in acute ischemic stroke, but no other scoring system has included DWI-ASPECTS in predicting patient outcome after IV-rtPA or endovascular therapy. This study showed good accuracy in predicting good clinical outcome in acute ischemic stroke with relatively simple-to-use scoring system with MRI findings.

    Patient Care: Scoring of the patient with acute ischemic stroke will predict patient outcome, and may be a help in explaining patient’s condition and to decide to perform invasive therapy such as IV-rtPA / endovascular recanalization therapy or not.

    Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of the new outcome prediction score using DWI-ASPECTS after IV-rtPA or endovascular therapy.

    References: Saposnik G, Guzik A, Reeves M et al. Stroke Prognostication using Age and NIH Stroke Scale. Neurology 2013;80:21-28. Alexander C, Bin X, Rishi G et al. THRIVE Score Predicts Outcomes With a Third-Generation Endovascular Stroke Treatment Device in the TREVO-2 Trial. Stroke 2013:44:3370-3375.

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