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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Association of CHA2DS2-VASc score with successful recanalization in acute ischemic stroke patients undergoing
Muharrem Nasifov1, Emre Ozmen2, Cigdem Deniz3
1Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey.
Insights
The pre-stroke CHA2DS2-VASc score predicts successful reperfusion in acute ischemic stroke patients undergoing thrombectomy. Higher scores indicate a greater likelihood of unsuccessful recanalization, highlighting its importance in stroke treatment outcomes.
Area of Science:
- Neurology
- Cardiology
- Interventional Radiology
Background:
- The CHA2DS2-VASc score assesses thromboembolic risk in non-valvular atrial fibrillation (AF) patients.
- Higher CHA2DS2-VASc scores correlate with increased stroke severity and poorer outcomes.
- The Modified Thrombolysis in Cerebral Infarction (mTICI) score evaluates recanalization success in acute ischemic stroke (AIS). mTICI 2c and 3 are considered successful.
Purpose of the Study:
- To investigate the association between pre-stroke CHA2DS2-VASc score and mTICI recanalization success in AIS patients.
- To evaluate this association in patients with and without atrial fibrillation undergoing percutaneous thrombectomy.
Main Methods:
- 159 AIS patients treated within 6 hours of symptom onset were included.
- All patients underwent endovascular treatment (thrombectomy).
- Pre-stroke CHA2DS2-VASc scores were calculated, and mTICI scores were assessed post-treatment.
Main Results:
- Successful reperfusion (mTICI ≥ 2c) occurred in 81.8% of patients.
- Patients with unsuccessful reperfusion were older and had significantly higher CHA2DS2-VASc scores (4.1 vs. 3.04, p=0.002).
- CHA2DS2-VASc score (OR=1.43) and procedure time (OR=1.03) were independent predictors of successful reperfusion.
- An optimal CHA2DS2-VASc score threshold of 3.5 predicted successful reperfusion (AUC: 0.669, p=0.005).
Conclusions:
- Pre-stroke CHA2DS2-VASc score is associated with recanalization success (mTICI 2c/3) in AIS patients undergoing endovascular treatment, irrespective of AF.
- This finding, novel in the literature, suggests CHA2DS2-VASc score may be a useful predictor in acute stroke interventions.
- Further large-scale studies are warranted to validate these findings.
Introduction:
The CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease and sex) score is a simple risk stratification algorithm to estimate stroke/thromboembolic risk in patients with non-valvular atrial fibrillation (AF). Higher pre-stroke CHA2DS2-VASc score is known to be associated with greater stroke severity and poorer outcomes. AF patients generally have higher CHA2DS2-VASc scores than non-AF patients. The Modified Thrombolysis in Cerebral Infarction (mTICI) score is the most widely used grading system to assess the result of recanalizing therapies in acute ischemic stroke (AIS). mTICI 2c and mTICI 3 are conventionally accepted as successful recanalization.
Aim:
We investigated whether pre-stroke CHA2DS2-VASc score is associated with mTICI recanalization score in AIS patients with and without AF undergoing percutaneous thrombectomy.
Material And Methods:
One hundred fifty-nine patients with the diagnosis of AIS who were admitted within 6 h from symptom onset were included in the study (mean age: 65.7 ±12.9). All subjects underwent endovascular treatment. CHA2DS2-VASc scores of the participants were calculated. Subjects were grouped according to mTICI scores achieved after endovascular treatment. mTICI 2c and mTICI 3 were accepted as successful recanalization.
Results:
Successful reperfusion was observed in 130 (81.8%) of all patients who underwent endovascular treatment (mTICI flow ≥ 2c) and first-pass reperfusion was observed in 107 (67.3%) patients. When the patients with successful (mTICI flow ≥ 2c) and unsuccessful (mTICI flow ≤ 2b) reperfusion were divided into groups, no significant difference was observed between the patients in terms of comorbidities such as AF, hypertension, hyperlipidemia, coronary artery disease and cerebrovascular accident history. Patients with unsuccessful reperfusion were older than patients with successful reperfusion (71.4 ±11.2 vs. 64.5 ±13.01, p = 0.006), with a higher CHA2DS2-VASc score (4.1 ±1.5 vs. 3.04 ±1.6, p = 0.002). In addition, the duration of the procedure was longer in the unsuccessful reperfusion group (92.4 ±27.2 min vs. 65.0 ±25.1 min, p < 0.001). CHA2DS2-VASc score significantly correlated with successful recanalization (correlation coefficient; 0.243, p = 0.002). Multivariate logistic regression analysis revealed that only CHA2DS2-VASc score (OR = 1.43, 95% CI: 1.09-1.87, p = 0.006) and procedure time (OR = 1.03, 95% CI: 1.01-1.05, p < 0.001) were independent predictors of successful reperfusion. The receiver-operating characteristic (ROC) curve was used to determine the cut-off value for the CHA2DS2-VASc score that best predicts successful reperfusion. The optimal threshold was 3.5, with a sensitivity of 58.6% and specificity of 59.2% (area under the curve (AUC): 0.669, p = 0.005).
Conclusions:
For the first time in the literature, we investigated and demonstrated that pre-stroke CHA2DS2-VASc score was associated with success of recanalization as assessed with mTICI 2c and mTICI 3 in a cohort of AIS patients regardless of AF presence who underwent endovascular treatment. Our findings deserve to be tested with large scale long term studies.
