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Selection of anterior circulation acute stroke patients for mechanical thrombectomy

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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.

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Acknowledgements

This work was supported by the Italian Ministry of Health (RF-2013-02358679). We are grateful to Francesco Mori MD, Simone Napolitano, Domenico Samà MD, Barbara Rizzato MD, Vittoria Carla D’Agostino MD, Angela Giordano MD, Marta Panella MD for data collection.

Funding

None in study design, collection, analysis and interpretation of data, writing and decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Systems Medicine, Stroke Center, University of Tor Vergata, viale Oxford 81, 00133, Rome, Italy

    Fabrizio Sallustio, Alfredo Paolo Mascolo, Federico Marrama, Fana Alemseged, Giacomo Koch & Marina Diomedi

  2. Santa Lucia Foundation, via Ardeatina 306, 00142, Rome, Italy

    Fabrizio Sallustio & Giacomo Koch

  3. Department of Biomedicine and Prevention, University of Tor Vergata, via Montpellier 1, 00133, Rome, Italy

    Nicola Toschi

  4. Department of Interventional Radiology, University of Tor Vergata, viale Oxford 81, Rome, Italy

    Daniele Morosetti, Valerio Da Ros & Roberto Gandini

Authors
  1. Fabrizio Sallustio
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  2. Nicola Toschi
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  3. Alfredo Paolo Mascolo
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  4. Federico Marrama
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  7. Roberto Gandini
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  8. Fana Alemseged
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  9. Giacomo Koch
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  10. Marina Diomedi
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Corresponding author

Correspondence to Fabrizio Sallustio.

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None of the authors has conflict of interest to declare.

Ethical Standards

The study was approved by Tor Vergata Hospital ethics committee.

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Informed consent was obtained from all patients or their relatives.

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Sallustio, F., Toschi, N., Mascolo, A.P. et al. Selection of anterior circulation acute stroke patients for mechanical thrombectomy. J Neurol 266, 2620–2628 (2019). https://doi.org/10.1007/s00415-019-09454-2

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  • DOI: https://doi.org/10.1007/s00415-019-09454-2

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