on April 9, 2009
Published online before print April 9, 2009, doi: 10.1161/STROKEAHA.108.535146
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Submitted on August 19, 2008
From the Vascular Neurology Program (H.H., A.D.B., A.T.A., J.C.G., S.I.S.) and the Neurology Department, Statistical Analysis and Data Management Division (M.M.M.), The University of Texas at Houston, Houston ,Texas; The University of California Los Angeles Stroke Center (D.S.L., J.G., J.L.S.), Los Angeles, Calif; and Tulane University Hospital and Clinic Stroke Center (S.B.M.-S.), New Orleans, La. * To whom correspondence should be addressed. E-mail: sean.i.savitz{at}uth.tmc.edu.
Background and Purpose—Intra-arterial recanalization therapy (IAT) is increasingly used for acute stroke. Despite high rates of recanalization, the outcome is variable. We attempted to identify predictors of outcome that will enable better patient selection for IAT. Methods—All patients who underwent IAT at the University of Texas Houston Stroke Center were reviewed. Poor outcome was defined as modified Rankin Scale score 4 to 6 on hospital discharge. Findings were validated in an independent data set of 175 patients from the University of California at Los Angeles Stroke Center. Results—One hundred ninety patients were identified. Mean age was 62 years and median baseline National Institutes of Health Stroke Scale score was 0.18. Recanalization rate was 75%, symptomatic hemorrhage rate was 6%, and poor outcome rate was 66%. Variables associated with poor outcome were: age, baseline National Institutes of Health Stroke Scale, admission glucose, diabetes, heart disease, previous stroke, and the absence of mismatch on the pretreatment MRI. Logistic regression identified 3 variables independently associated with poor outcome: age (P=0.049; OR, 1.028), National Institutes of Health Stroke Scale (P=0.013; OR, 1.084), and admission glucose (P=0.031; OR, 1.011). Using these data, we devised the Houston IAT score: 1 point for age >75 years; 1 for National Institutes of Health Stroke Scale score >18, and 1 point for glucose >150 mg/dL (range, 0 to 3 mg/dL). The percentage of poor outcome by Houston IAT score was: score of 0, 44%; 1, 67%; 2, 97%; and 3, 100%. Recanalization rates were similar across the scores (P=0.4). Applying Houston IAT to the external cohort showed comparable trends in outcome and nearly identical rates in the Houston IAT therapy 3 tier. Conclusions—The Houston IAT score estimates the chances of poor outcome after IAT, even with recanalization. It may be useful in comparing cohorts of patients and when assessing the results of clinical trials.
Accepted on August 29, 2008
Identifying Patients at High Risk for Poor Outcome After Intra-Arterial Therapy for Acute Ischemic Stroke
Hen Hallevi MD;
Key words: acute care • acute stroke • interventional neuroradiology • thrombolysis