Abstract T P50: ASTRAL-R score Predicts absence of Recanalization after Intravenous Thrombolysis in Acute Ischemic Stroke
Background: Intravenous thrombolysis (IVT) is the best proven recanalization treatment in acute ischemic stroke (AIS), but may be insufficient or of little value in certain patients. By predicting the probability of absence of recanalization after IVT, the decision for more aggressive revascularization treatment can be individualized with the goal to improve clinical outcome.
Aim: To derive and internally validate a predictive scoring system for absence of recanalization with IVT, using readily available variables in the prehospital and emergency room phase.
Methods: Data from prospective thrombolysis registries of four academic stroke centers were examined. Patients with arterial occlusion on acute imaging and repeat arterial assessment at 24hours were selected. Based on a logistic regression analysis, an integer-based score for each covariate of the fitted multivariate model was generated. The overall score was calculated as the sum of the weighted scores. In a patient with an ASTRAL-R score > 3, the likelihood of absence of recanalization was > 50%. The area under the receiver-operator curve was 0.65 in the derivation cohort.
Results: In 534 thrombolyzed AIS patients, five variables were identified as independent predictors of absence of recanalization: Acute glucose >7mmol/L (A), significant extracranial vessel STenosis (ST), decreased Range of visual fields (R), proximal Arterial occlusion (A) and altered Level of consciousness (L). An altered level of consciousness was weighted 2 and all other variables 1 point based on β-coefficients. In a patient with an ASTRAL-R score > 3, the likelihood of absence of recanalization was >50%. The score was highly predictive (OR 0.65, 95%CI 0.55-0.76) in the derivation cohort.
Conclusions: A simple 5-item ASTRAL-R score shows high prediction for absence of recanalization at 24hours in thrombolyzed AIS patients. If confirmed by external validation, planning for more aggressive revascularization strategies may facilitate through this tool.
Author Disclosures: P. Vanacker: None. D. Lambrou: None. M. Heldner: None. D. Seiffge: None. H. Mueller: None. A. Eskandari: None. G. Ntaios: None. P.J. Mosimann: None. R. Sztajzel: None. V. Mendes Pereira: None. P. Cras: None. S. Engelter: None. P. Lyrer: None. U. Fischer: None. M. Arnold: None. P. Michel: None.
- © 2014 by American Heart Association, Inc.