Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke.
OBJECTIVE
Intra-arterial therapy (IAT) promotes recanalization of large artery occlusions in acute ischemic stroke. Despite high recanalization rates, poor clinical outcomes are common. We attempted to optimize a score that combines clinical and imaging variables to more accurately predict poor outcome after IAT in anterior circulation occlusions.


METHODS
Patients with acute ischemic stroke undergoing IAT at University of Texas (UT) Houston for large artery occlusions (middle cerebral artery or internal carotid artery) were reviewed. Independent predictors of poor outcome (modified Rankin Scale, 4-6) were studied. External validation was performed on IAT-treated patients at Emory University.


RESULTS
A total of 163 patients were identified at UT Houston. Independent predictors of poor outcome (P≤0.2) were identified as score variables using sensitivity analysis and logistic regression. Houston Intra-Arterial Therapy 2 (HIAT2) score ranges 0 to 10: age (≤59=0, 60-79=2, ≥80 years=4), glucose (<150=0, ≥150=1), National Institute Health Stroke Scale (≤10=0, 11-20=1, ≥21=2), the Alberta Stroke Program Early CT Score (8-10=0, ≤7=3). Patients with HIAT2≥5 were more likely to have poor outcomes at discharge (odds ratio, 6.43; 95% confidence interval, 2.75-15.02; P<0.001). After adjusting for reperfusion (Thrombolysis in Cerebral Infarction score≥2b) and time from symptom onset to recanalization, HIAT2≥5 remained an independent predictor of poor outcome (odds ratio, 5.88; 95% confidence interval, 1.96-17.64; P=0.02). Results from the cohort of Emory (198 patients) were consistent; patients with HIAT2 score≥5 had 6× greater odds of poor outcome at discharge and at 90 days. HIAT2 outperformed other previously published predictive scores.


CONCLUSIONS
The HIAT2 score, which combines clinical and imaging variables, performed better than all previous scores in predicting poor outcome after IAT for anterior circulation large artery occlusions.
From the Department of Neurology, University of Texas, Houston (A.S., A.D.B., C.W.S., J.C., S.L.L., W.B., C.B.N., O.M., F.V., T.-C.W., G.A.L., N.R.G., R.E., P.R.C., M.D., J.C.G., S.I.S.); Department of Neurology, University of Alabama, Birmingham (K.A., A.K.B.); Department of Neurology, Tulane University, New Orleans, LA (S.M.-S.); Department of Neurology, Emory University, Atlanta, GA (C.-H.J.S., R.G.N., R.G.); Department of Neurology, Sourasky Medical Center, Tel Aviv, Israel (H.H.); and Department of Neurology, University of California, Los Angeles (J.L.S., D.S.L.).
Amrou
A
Sarraj
Karen
K
Albright
Andrew D
AD
Barreto
Amelia K
AK
Boehme
Clark W
CW
Sitton
Jeanie
J
Choi
Steven L
SL
Lutzker
Chung-Huan J
CH
Sun
Wafi
W
Bibars
Claude B
CB
Nguyen
Osman
O
Mir
Farhaan
F
Vahidy
Tzu-Ching
TC
Wu
George A
GA
Lopez
Nicole R
NR
Gonzales
Randall
R
Edgell
Sheryl
S
Martin-Schild
Hen
H
Hallevi
Peng Roc
PR
Chen
Mark
M
Dannenbaum
Jeffrey L
JL
Saver
David S
DS
Liebeskind
Raul G
RG
Nogueira
Rishi
R
Gupta
James C
JC
Grotta
Sean I
SI
Savitz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D015424:Reperfusion; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
HIAT2; acute ischemic stroke; intra-arterial therapy; prediction scores; thrombolysis