title: A score based on age and DWI volume predicts poor outcome following endovascular treatment for acute ischemic stroke.
abstract: OBJECTIVE
  The Houston Intra-Arterial Therapy score predicts poor functional outcome following endovascular treatment for acute ischemic stroke based on clinical variables. The present study sought to (a) create a predictive scoring system that included a neuroimaging variable and (b) determine if the scoring systems predict the clinical response to reperfusion.
  
  
  METHODS
  Separate datasets were used to derive (n = 110 from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 study) and validate (n = 125 from Massachusetts General Hospital) scoring systems that predict poor functional outcome, defined as a modified Rankin Scale score of 4-6 at 90 days.
  
  
  RESULTS
  Age (P < 0·001; β = 0·087) and diffusion-weighted imaging volume (P = 0·023; β = 0·025) were the independent predictors of poor functional outcome. The Stanford Age and Diffusion-Weighted Imaging score was created based on the patient's age (0-3 points) and diffusion-weighted imaging lesion volume (0-1 points). The percentage of patients with a poor functional outcome increased significantly with the number of points on the Stanford Age and Diffusion-Weighted Imaging score (P < 0·01 for trend). The area under the receiver operating characteristic curve for the Stanford Age and Diffusion-Weighted Imaging score was 0·82 in the derivation dataset. In the validation cohort, the area under the receiver operating characteristic curve was 0·69 for the Stanford Age and Diffusion-Weighted Imaging score and 0·66 for the Houston Intra-Arterial Therapy score (P = 0·45 for the difference). Reperfusion, but not the interactions between the prediction scores and reperfusion, were predictors of outcome (P > 0·5).
  
  
  CONCLUSIONS
  The Stanford Age and Diffusion-Weighted Imaging and Houston Intra-Arterial Therapy scores can be used to predict poor functional outcome following endovascular therapy with good accuracy. However, these scores do not predict the clinical response to reperfusion. This limits their utility as tools to select patients for acute stroke interventions.
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: John T P
authors.initials: JT
authors.lastname: Liggins
authors.affiliation: Department of Radiology, Division of Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Nishant K
authors.initials: NK
authors.lastname: Mishra
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Hayley M
authors.initials: HM
authors.lastname: Wheeler
authors.affiliation: Department of Radiology, Lucas Magnetic Resonance Spectroscopy and Imaging Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Matus
authors.initials: M
authors.lastname: Straka
authors.affiliation: Department of Radiology, Division of Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Thabele M
authors.initials: TM
authors.lastname: Leslie-Mazwi
authors.affiliation: Department of Radiology, Division of Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Zeshan A
authors.initials: ZA
authors.lastname: Chaudhry
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kemp
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.affiliation: Department of Radiology, Lucas Magnetic Resonance Spectroscopy and Imaging Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Roland
authors.initials: R
authors.lastname: Bammer
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002545:Brain Ischemia / Q000150:complications; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute care; acute stroke; interventional neuroradiology; thrombolysis