From the Department of Neurology, University of Texas, Houston (A.S., A.D.B., C.W.S., J.C., S.L.L., W.B., C.B.N., O.M., F.V., T.-C.W., G.A.L., N.R.G., R.E., P.R.C., M.D., J.C.G., S.I.S.); Department of Neurology, University of Alabama, Birmingham (K.A., A.K.B.); Department of Neurology, Tulane University, New Orleans, LA (S.M.-S.); Department of Neurology, Emory University, Atlanta, GA (C.-H.J.S., R.G.N., R.G.); Department of Neurology, Sourasky Medical Center, Tel Aviv, Israel (H.H.); and Department of Neurology, University of California, Los Angeles (J.L.S., D.S.L.).
Stroke. 2013 Dec;44(12):3324-30. doi: 10.1161/STROKEAHA.113.001050. Epub 2013 Aug 8.
Intra-arterial therapy (IAT) promotes recanalization of large artery occlusions in acute ischemic stroke. Despite high recanalization rates, poor clinical outcomes are common. We attempted to optimize a score that combines clinical and imaging variables to more accurately predict poor outcome after IAT in anterior circulation occlusions.
Patients with acute ischemic stroke undergoing IAT at University of Texas (UT) Houston for large artery occlusions (middle cerebral artery or internal carotid artery) were reviewed. Independent predictors of poor outcome (modified Rankin Scale, 4-6) were studied. External validation was performed on IAT-treated patients at Emory University.
A total of 163 patients were identified at UT Houston. Independent predictors of poor outcome (P≤0.2) were identified as score variables using sensitivity analysis and logistic regression. Houston Intra-Arterial Therapy 2 (HIAT2) score ranges 0 to 10: age (≤59=0, 60-79=2, ≥80 years=4), glucose (<150=0, ≥150=1), National Institute Health Stroke Scale (≤10=0, 11-20=1, ≥21=2), the Alberta Stroke Program Early CT Score (8-10=0, ≤7=3). Patients with HIAT2≥5 were more likely to have poor outcomes at discharge (odds ratio, 6.43; 95% confidence interval, 2.75-15.02; P<0.001). After adjusting for reperfusion (Thrombolysis in Cerebral Infarction score≥2b) and time from symptom onset to recanalization, HIAT2≥5 remained an independent predictor of poor outcome (odds ratio, 5.88; 95% confidence interval, 1.96-17.64; P=0.02). Results from the cohort of Emory (198 patients) were consistent; patients with HIAT2 score≥5 had 6× greater odds of poor outcome at discharge and at 90 days. HIAT2 outperformed other previously published predictive scores.
The HIAT2 score, which combines clinical and imaging variables, performed better than all previous scores in predicting poor outcome after IAT for anterior circulation large artery occlusions.
动脉内治疗（IAT）可促进急性缺血性脑卒中的大动脉闭塞再通。尽管再通率较高，但临床结局仍较差。我们试图优化一种评分，将临床和影像学变量相结合，以更准确地预测前循环闭塞的 IAT 后不良结局。
回顾在德克萨斯大学（UT）休斯顿接受 IAT 治疗的大动脉闭塞（大脑中动脉或颈内动脉）的急性缺血性脑卒中患者。研究了不良结局（改良 Rankin 量表，4-6 分）的独立预测因素。在埃默里大学接受 IAT 治疗的患者中进行了外部验证。
在 UT 休斯顿共确定了 163 例患者。通过敏感性分析和逻辑回归确定了不良结局的独立预测因素（P≤0.2）作为评分变量。休斯顿动脉内治疗 2 （HIAT2）评分范围为 0 至 10：年龄（≤59 岁=0，60-79 岁=2，≥80 岁=4），血糖（<150=0，≥150=1），国立卫生研究院卒中量表（≤10=0，11-20=1，≥21=2），阿尔伯塔卒中计划早期 CT 评分（8-10=0，≤7=3）。HIAT2≥5 的患者出院时更有可能出现不良结局（优势比，6.43；95%置信区间，2.75-15.02；P<0.001）。在校正再灌注（溶栓治疗脑梗死评分≥2b）和症状发作至再通时间后，HIAT2≥5 仍然是不良结局的独立预测因素（优势比，5.88；95%置信区间，1.96-17.64；P=0.02）。埃默里大学队列的结果一致；HIAT2 评分≥5 的患者出院和 90 天时不良结局的可能性增加 6 倍。HIAT2 优于其他先前发表的预测评分。
HIAT2 评分结合了临床和影像学变量，在预测前循环大动脉闭塞的 IAT 后不良结局方面优于所有先前的评分。
