1. Derivation and validation of a predictive scale to expedite endovascular intervention for acute stroke patients with an intervenable vessel occlusion.
- Author
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Ren Z, Wangqin R, Demiraj F, Li W, Mokin M, Wang A, Miao Z, Wang Y, and Burgin WS
- Subjects
- Humans, Male, Aged, Female, Retrospective Studies, Middle Aged, Aged, 80 and over, Severity of Illness Index, Stroke diagnostic imaging, Stroke therapy, Tomography, X-Ray Computed methods, Predictive Value of Tests, Endovascular Procedures methods, Ischemic Stroke diagnostic imaging, Ischemic Stroke therapy, Ischemic Stroke surgery
- Abstract
Background: Early endovascular intervention team mobilization may reduce reperfusion times and improve clinical outcomes for patients with acute ischemic stroke (AIS) with a possible intervenable vessel occlusion (IVO). In an emergency department or mobile stroke unit, incorporating rapidly available non-contrast CT (NCCT) information with examination findings may improve the accuracy of arterial occlusion prediction scales. For this purpose, we developed a rapid and straightforward IVO predictive instrument-the T
3 AM2 PA1 scale., Methods: The T3 AM2 PA1 scale was retrospectively derived from our 'Get with the Guidelines' database. We included all patients with acute stroke alert between January 2017 and August 2018 with a National Institutes of Health Stroke Scale (NIHSS) score between 5 and 25 inclusive. Different pre-intervention variables were collected, including itemized NIHSS and NCCT information. The T3 AM2 PA1 scale was also compared with other commonly used scales and was validated in a separate sequential retrospective cohort of patients with a full range of NIHSS scores., Results: 574 eligible patients from 2115 acute stroke alerts were identified. The scale was established with five items (CT hyperdense sign, parenchymal hypodensity, lateralizing hemiparesis, gaze deviation, and language disturbance), with a total score of 9. To minimize unnecessary angiography, a cut-off of ≥5 for IVO detection yielded a sensitivity of 52%, a specificity of 90%, and a positive predictive value of 76%., Conclusions: The T3 AM2 PA1 scale accurately predicts the presence of clinical IVO in patients with AIS. Adopting the T3 AM2 PA1 scale could reduce revascularization times, improve treatment outcomes, and potentially reduce disability., Competing Interests: Competing interests: WSB has received grants from Athersys, BMS, Florida High Tech Corridor, NIH, Reneuron, and VuEssence. His consulting activities include Genentech, VuEssence, with stock options in VuEssence. He has patents planned or pending with USF. His equity positions include holdings in Inur Technologies and Electron Transport Biotech. He also has a financial interest in PRIME Education. MM has received grants from the NIH and has consulted with Balt, Cerenovus, Medtronic, and Rapid Pulse. His testimony work includes Foley Mansfield and Huff Powell Bailey as clients. He has participated as an advisor for Cerenovus and Rapid Pulse. His financial holdings include Bendit Technologies, Borvo Medical, BrainQ, Endostream, Serenity Medical, Synchron, Sim & Cure, QAS AI, Quantanosis AI. ZR has received royalties for his publication on aneurysms and has lectured for Beijing Tiantan Hospital, the Chinese Stroke Association, and the Chinese Institute for Brain Research., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2024
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