Hallevi Hen, Barreto Andrew D, Liebeskind David S, Morales Miriam M, Martin-Schild Sheryl B, Abraham Anitha T, Gadia Jignesh, Saver Jeffrey L, Grotta James C, Savitz Sean I
Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
Stroke. 2009 May;40(5):1780-5. doi: 10.1161/STROKEAHA.108.535146. Epub 2009 Apr 9.
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.
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.
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.
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.
动脉内再通治疗（IAT）在急性卒中治疗中的应用日益广泛。尽管再通率较高，但治疗结果却存在差异。我们试图确定能够更好地为IAT选择合适患者的预后预测因素。
对在德克萨斯大学休斯顿卒中中心接受IAT治疗的所有患者进行了回顾性研究。预后不良定义为出院时改良Rankin量表评分为4至6分。研究结果在加利福尼亚大学洛杉矶分校卒中中心的175例独立患者数据集中进行了验证。
共纳入190例患者。平均年龄为62岁，基线美国国立卫生研究院卒中量表评分中位数为18分。再通率为75%，症状性出血率为6%，预后不良率为66%。与预后不良相关的变量包括：年龄、基线美国国立卫生研究院卒中量表评分、入院血糖、糖尿病、心脏病、既往卒中以及治疗前MRI不存在不匹配情况。逻辑回归分析确定了3个与预后不良独立相关的变量：年龄（P = 0.049；比值比[OR]，1.028）、美国国立卫生研究院卒中量表评分（P = 0.013；OR，1.084）和入院血糖（P = 0.031；OR，1.011）。利用这些数据，我们设计了休斯顿IAT评分：年龄>75岁得1分；美国国立卫生研究院卒中量表评分>18分得1分；血糖>150 mg/dL（范围，0至3分）得1分。根据休斯顿IAT评分得出的预后不良百分比为：评分为0分，44%；1分，67%；2分，97%；3分，100%。各评分组的再通率相似（P = 0.4）。将休斯顿IAT评分应用于外部队列，结果显示在预后方面有相似趋势且在休斯顿IAT治疗3个分层中的发生率几乎相同。
休斯顿IAT评分可评估IAT治疗后即使实现再通仍出现预后不良的可能性。它在比较患者队列以及评估临床试验结果时可能有用。
