Abstract T P2: A Clinical Score to Predict Major Arterial Occlusions Eligible for Endovascular Recanalization in Acute Stroke based on the ASTRAL registry
Aims: Endovascular treatment (EVT) for acute ischemic stroke (AIS) has the potential to improve clinical outcome in well selected patients with a major intracranial occlusion. This study aimed to identify easily available pre-hospital predictors and to develop a clinical score to detect AIS patients with such occlusions potentially eligible for acute EVT.
Methods: Consecutive AIS enrolled in the ASTRAL registry with good quality CT-angiography within 12h after onset were selected (1’645 patients, Lausanne) and categorized according to occlusion site. Easily accessible demographic and clinical information were used in a logistic regression analysis to derive predictors of major intracranial occlusions (intracranial carotid, basilar and M1-artery). A The score was created developed using the beta-logistic regression coefficients of the logistic regression analysis, and was validated internally and externally (848 patients, Bern).
Results: Major intracranial occlusions were present in 316 (21%) acute stroke patients in the derivation and 566 (28%) in the internal validation cohort. From all 12 significant predictors of major intracranial occlusions, a 7- item score was developed to obtain the best diagnostic performance; it was termed ASTRAL-O score according to its constituents: Admission NIHSS (A): (NIHSS 0-4: 0 points; 5-9: 4; 10-14: 8; ≥15: 12), absence of pre-STroke handicap (mRS≤2) (ST: 2 points), absence of previous STroke (ST: 1 point), Right-sided stroke (R: 3 points), Atrial fibrillation (A: 1 point), Level of consciousness decreased (L: 1 point) and wOmen (O:2 points). Diagnostic accuracy of the score in both the internal and external validation cohort was good at different cut-off levels (AUC 0.84 and 0.76 respectively). A Wilcoxon signed rank test showed that the ASTRAL-0 score performed better than NIHSS alone in term of predicted probabilities.
Conclusions: The ASTRAL-O score accurately predicts the major intracranial occlusions eligible for EVT. It improves predicted probabilities over the NIHSS alone. This tool could help to rapidly triage stroke patients in the hyper-acute phase
Author Disclosures: P. Vanacker: None. M. Heldner: None. M. Amiguet: None. M. Faouzi: None. P. Cras: None. G. Ntaios: None. M. Arnold: None. H.P. Mattle: None. U. Fischer: None. P. Michel: None.
- © 2015 by American Heart Association, Inc.