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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Pittsburgh Response to Endovascular therapy (PRE) score: optimizing patient selection for endovascular therapy for
Srikant Rangaraju1, Amin Aghaebrahim2, Christopher Streib2
1Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA.
Insights
The Pittsburgh Response to Endovascular therapy (PRE) score effectively predicts good outcomes for stroke patients receiving endovascular therapy, aiding in treatment selection. This validated tool helps identify which patients benefit most from this intervention.
Area of Science:
- Neurology
- Interventional Radiology
- Clinical Prediction Modeling
Background:
- Endovascular therapy is a key treatment for large vessel occlusion (LVO) strokes.
- Identifying patients most likely to benefit from endovascular therapy is crucial for optimizing outcomes.
- A need exists for a reliable clinical tool to guide patient selection for this intervention.
Purpose of the Study:
- To develop and validate a clinical tool, the Pittsburgh Response to Endovascular therapy (PRE) score, for predicting good outcomes in patients with anterior circulation LVO undergoing endovascular therapy.
- To compare the predictive performance of the PRE score against existing prognostic tools.
Main Methods:
- A derivation cohort (N=247) was used to identify independent predictors of good outcome (90-day mRS 0-2) via logistic regression.
- The PRE score was formulated using age, NIHSS, and ASPECTS.
- The score was validated in two independent cohorts (UPMC, N=393; UIVH, N=204) and compared with THRIVE, SPAN, HIAT2, and iSCORE.
Main Results:
- The PRE score (age + 2×NIHSS - 10 × ASPECTS) demonstrated strong predictive power in derivation (AUC=0.79) and validation cohorts (UPMC AUC=0.79; UIVH AUC=0.72).
- PRE showed superiority over THRIVE and SPAN, with a trend towards superiority over HIAT2 and iSCORE.
- Successful recanalization correlated with better outcomes for patients with PRE scores between -24 and +49.
Conclusions:
- The PRE score is a validated and effective tool for predicting outcomes in patients with anterior circulation LVO.
- The PRE score can aid in patient selection for endovascular therapy, potentially improving treatment efficacy.
Background:
Endovascular therapy seems to benefit a subset of patients with large vessel occlusion strokes. We aimed to develop a clinically useful tool to identify patients who are likely to benefit from endovascular therapy.
Methods:
In a derivation cohort of consecutively treated patients with anterior circulation large vessel occlusion (Grady Memorial Hospital, N=247), independent predictors (p<0.1) of good outcome (90-day modified Rankin scale score (mRS) 0-2) were determined using logistic regression to derive the Pittsburgh Response to Endovascular therapy (PRE) score as a predictor of good outcome. The PRE score was validated in two institutional cohorts (University of Pittsburgh Medical Center (UPMC): N=393; Unitat d'Ictus Vall d'Hebron: N=204) and its discriminative power for good outcome was compared with other validated tools. Benefit of successful recanalization was assessed in PRE score groups.
Results:
Independent predictors of good outcome in the derivation cohort (age, baseline National Institute of Health Stroke Scale (NIHSS) score and Alberta Stroke Program Early CT Score (ASPECTS)) were used in the model: PRE score=age (years)+2×NIHSS-10 × ASPECTS. PRE score was highly predictive of good outcome in the derivation cohort (area under the curve (AUC)=0.79) and validation cohorts (UPMC: AUC=0.79; UIVH: AUC=0.72) with comparable rates of good outcome in all PRE risk quartiles. PRE was superior to Totaled Health Risks In Vascular Events (THRIVE) (p=0.03) and Stroke Prognostication using Age and NIHSS (SPAN) (p=0.007), with a trend towards superiority to Houston Intra-Arterial Therapy 2 (HIAT2) (p=0.06) and iSCORE (p=0.051) in predicting good outcomes. Better outcomes were associated with successful recanalization in patients with PRE scores -24 to +49 but not in patients with PRE scores <-24 or ≥ 50.
Conclusions:
The PRE score is a validated tool that predicts outcomes and may facilitate patient selection for endovascular therapy in anterior circulation large vessel occlusions.
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