Fabrizio Sallustio1,2, Nicola Toschi3, Alfredo Paolo Mascolo4, Federico Marrama4, Daniele Morosetti5, Valerio Da Ros5, Roberto Gandini5, Fana Alemseged4, Giacomo Koch4,6, Marina Diomedi4. 1. Department of Systems Medicine, Stroke Center, University of Tor Vergata, viale Oxford 81, 00133, Rome, Italy. fsall75@gmail.com. 2. Santa Lucia Foundation, via Ardeatina 306, 00142, Rome, Italy. fsall75@gmail.com. 3. Department of Biomedicine and Prevention, University of Tor Vergata, via Montpellier 1, 00133, Rome, Italy. 4. Department of Systems Medicine, Stroke Center, University of Tor Vergata, viale Oxford 81, 00133, Rome, Italy. 5. Department of Interventional Radiology, University of Tor Vergata, viale Oxford 81, Rome, Italy. 6. Santa Lucia Foundation, via Ardeatina 306, 00142, Rome, Italy.
Abstract
BACKGROUND: The use of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) patients has increased with a parallel burden in procedural costs. We tested whether a new prognostic score could identify patients who are unlikely to benefit from MT. METHODS: Patients from our endovascular stroke registry were assessed for imaging and clinical outcome measures and randomly divided into two subsets for derivation and validation. We created a new prognostic score based on clinical and radiological prognostic factors of poor outcome (mRS score ≥ 3) from the derivation cohort. Receiver operating characteristics curve analysis was used to assess the discrimination ability of the score. The score was then validated and compared to the MR PREDICTS score. RESULTS: The derivation/validation included 270/116 patients, respectively. After multivariate logistic regression analysis, pre stroke mRS, age, admission glycaemia, admission NIHSS, collateral flow, Clot Burden Score, Alberta Stroke Program Early CT score were used to create a new prognostic scoring system called Tor Vergata Stroke Score (TVSS). TVSS revealed a good prognostic accuracy with an AUC of 0.825 [95% CI 0.77-0.88] in the derivation cohort and an AUC of 0.820 [95% CI 0.74-0.90] in the validation cohort. When compared to the MR PREDICTS in the validation cohort, TVSS demonstrated higher prediction ability which was, however, not statistically significant (0.80 vs 0.78; P = 0.26). CONCLUSIONS: TVSS is a reliable tool for selection of AIS candidates for MT and optimization of transfer to comprehensive stroke centers.
BACKGROUND: The use of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) patients has increased with a parallel burden in procedural costs. We tested whether a new prognostic score could identify patients who are unlikely to benefit from MT. METHODS:Patients from our endovascular stroke registry were assessed for imaging and clinical outcome measures and randomly divided into two subsets for derivation and validation. We created a new prognostic score based on clinical and radiological prognostic factors of poor outcome (mRS score ≥ 3) from the derivation cohort. Receiver operating characteristics curve analysis was used to assess the discrimination ability of the score. The score was then validated and compared to the MR PREDICTS score. RESULTS: The derivation/validation included 270/116 patients, respectively. After multivariate logistic regression analysis, pre stroke mRS, age, admission glycaemia, admission NIHSS, collateral flow, Clot Burden Score, Alberta Stroke Program Early CT score were used to create a new prognostic scoring system called Tor Vergata Stroke Score (TVSS). TVSS revealed a good prognostic accuracy with an AUC of 0.825 [95% CI 0.77-0.88] in the derivation cohort and an AUC of 0.820 [95% CI 0.74-0.90] in the validation cohort. When compared to the MR PREDICTS in the validation cohort, TVSS demonstrated higher prediction ability which was, however, not statistically significant (0.80 vs 0.78; P = 0.26). CONCLUSIONS: TVSS is a reliable tool for selection of AIS candidates for MT and optimization of transfer to comprehensive stroke centers.
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