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Clinically Approximated Hypoperfused Tissue in Large Vessel Occlusion Stroke.

Shashvat M Desai1, Santiago Ortega-Gutierrez2, Sunil A Sheth3

  • 1Department of Neurology (S.M.D., A.P.J.), University of Pittsburgh Medical Center, PA.

Stroke
|May 11, 2021
PubMed
Summary

A new method uses the National Institutes of Health Stroke Scale (NIHSS) score to estimate brain tissue at risk in large vessel occlusion strokes. This approach accurately identifies patients eligible for thrombectomy in the delayed window.

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Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Stroke Imaging

Background:

  • Selecting patients for thrombectomy in acute ischemic stroke with large vessel occlusion (LVO) in the delayed window (>6 hours) typically relies on perfusion imaging to identify clinical-core or target mismatch.
  • Advanced imaging and software processing can delay treatment and limit eligibility for thrombectomy.
  • Alternative selection methods are needed to expedite treatment and broaden patient access.

Purpose of the Study:

  • To develop a conversion factor to approximate the volume of hypoperfused tissue using the National Institutes of Health Stroke Scale (NIHSS) score, termed clinically approximated hypoperfused tissue (CAT) volume.
  • To evaluate the ability of CAT volume to identify patients eligible for thrombectomy in the late time window.

Main Methods:

  • Retrospective analysis of 309 anterior circulation LVO strokes across three comprehensive stroke centers.
  • Derivation of conversion factors based on NIHSS score (<10 and ≥10) and median Tmax >6 seconds volume from an initial cohort.
  • Testing CAT-based eligibility criteria against DEFUSE-3 criteria (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) in an independent validation cohort.

Main Results:

  • 38% of patients presented beyond 6 hours from last known well.
  • Derived conversion factors were 15 for NIHSS <10 and 6 for NIHSS ≥10.
  • CAT volume-based eligibility criteria demonstrated 100% sensitivity and 92% specificity in identifying DEFUSE-3 eligible patients (AUC, 0.92) in the validation cohort.

Conclusions:

  • Stroke clinical severity, measured by NIHSS score, can be utilized to estimate hypoperfused tissue volume in LVO stroke.
  • CAT volumes, calculated using NIHSS score-based factors (15 for <10, 6 for ≥10), accurately identify patients eligible for thrombectomy under DEFUSE-3 criteria.
  • This simplified approach may facilitate broader and more timely eligibility assessment for late-window thrombectomy.