Pittsburgh Outcomes After Stroke Thrombectomy Score Predicts Outcomes After Endovascular Therapy for Anterior Circulation Large Vessel Occlusions
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- Srikant Rangaraju
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- John T.P. Liggins
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Amin Aghaebrahim
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Christopher Streib
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Chung-Huan Sun
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Rishi Gupta
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Raul Nogueira
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Michael Frankel
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Michael Mlynash
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Maarten Lansberg
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Gregory Albers
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Ashutosh Jadhav
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
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- Tudor G. Jovin
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
説明
<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Prognostication tools that predict good outcome in patients with anterior circulation large vessel occlusions after endovascular therapy are lacking. We aim to develop a tool that incorporates clinical and imaging data to predict outcomes after endovascular therapy.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>In a derivation cohort of anterior circulation large vessel occlusion stroke patients treated with endovascular therapy within 8 hours from time last seen well (n=247), we performed logistic regression to identify independent predictors of good outcome (90-day modified Rankin Scale, 0–2). Factors were weighted based on β-coefficients to derive the Pittsburgh Outcomes After Stroke Thrombectomy (POST) score. POST was validated in an institutional endovascular database (University of Pittsburgh Medical Center, n=393) and the Diffusion-Weighted Imaging Evaluation for Understanding Stroke Evolution Study-2 (DEFUSE-2) data set (n=105), as well as in patients treated beyond 8 hours (n=194) and in octogenarians (n=111).</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> In the derivation cohort, independent predictors ( <jats:italic>P</jats:italic> <0.1) of good outcome included 24- to 72-hour final infarct volume (in cm <jats:sup>3</jats:sup> , <jats:italic>P</jats:italic> <0.001), age (years, <jats:italic>P</jats:italic> <0.001), and parenchymal hematoma types 1 and 2 (H, <jats:italic>P</jats:italic> =0.01). POST was calculated as age+0.5×final infarct volume+15×H. Patients with POST score <60 had a 91% chance of good outcome compared with 4% with POST score ≥120. POST accurately predicted good outcomes in the derivation (area under the curve [AUC]=0.85) and validation cohorts (University of Pittsburgh Medical Center, AUC=0.81; DEFUSE-2, AUC=0.86), as well as in patients treated beyond 8 hours (AUC, 0.85) and octogenarians (AUC=0.76). POST had better predictive accuracy for good and poor outcome than the ischemic stroke predictive risk score (iSCORE). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>POST score is a validated predictor of outcome in patients with anterior circulation large vessel occlusions after endovascular therapy.</jats:p> </jats:sec>
収録刊行物
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- Stroke
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Stroke 45 (8), 2298-2304, 2014-08
Ovid Technologies (Wolters Kluwer Health)