V Martins-Filho Rui Kleber do, Dias Francisco A, Alves Frederico F A, Camilo Millene R, Barreira Clara M A, Libardi Milena C, Abud Daniel G, Pontes-Neto Octavio M
Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil.
Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil.
J Stroke Cerebrovasc Dis. 2019 Apr;28(4):869-875. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.003. Epub 2018 Dec 29.
The results of recent trials of mechanical thrombectomy for acute ischemic stroke have increased the demand for identification of patients with large vessel occlusion (LVO) at the primary stroke center, where a prompt detection may expedite transfer to a comprehensive stroke center for endovascular treatment. However, in developing countries, a noncontrast computed tomography (NCCT) may be the only neuroimaging modality available at the primary stroke center scenario, what calls for a screening strategy accurate enough to avoid unnecessary transfers of noneligible patients for endovascular therapy. Algorithms based on National Institute of Health Stroke Scale (NIHSS) and NCCT findings can be used to screen for LVO in patients with anterior circulation stroke (ACS).
To test the accuracy of a score based on NIHSS and NCCT to detect LVO in patients with ACS.
We evaluated 178 patients from a prospective stroke registry of patients admitted to an academic tertiary emergency unit. NIHSS and vessel attenuation values of the middle cerebral artery on NCCT absolute vessel attenuation (VA) were collected by 2 investigators that were blind to CT angiography (CTA) findings. We used receiver operating characteristics curve analysis and C-statistics to predict LVO on CTA.
NIHSS and vessel attenuation were highly associated with LVO with an area under the curve (AUC) of .86 and .77. The LVO score, built by logistic regression coefficients of the NIHSS and VA, showed the highest accuracy for the presence of LVO on CTA (AUC of .91).
The LVO score may be a useful screening approach to identify LVO in patients with ACS.
近期急性缺血性卒中机械取栓试验的结果增加了在初级卒中中心识别大血管闭塞（LVO）患者的需求，在初级卒中中心迅速检测到LVO可加快将患者转运至综合卒中中心进行血管内治疗。然而，在发展中国家，非增强计算机断层扫描（NCCT）可能是初级卒中中心唯一可用的神经影像学检查方式，这就需要一种足够准确的筛查策略，以避免将不符合条件的患者不必要地转运去接受血管内治疗。基于美国国立卫生研究院卒中量表（NIHSS）和NCCT结果的算法可用于筛查前循环卒中（ACS）患者的LVO。
检验基于NIHSS和NCCT的评分检测ACS患者LVO的准确性。
我们评估了来自一所学术性三级急诊单元前瞻性卒中登记处的178例患者。由2名对CT血管造影（CTA）结果不知情的研究人员收集NIHSS和NCCT上大脑中动脉的血管衰减值即绝对血管衰减（VA）。我们使用受试者工作特征曲线分析和C统计量来预测CTA上的LVO。
NIHSS和血管衰减与LVO高度相关，曲线下面积（AUC）分别为0.86和0.77。由NIHSS和VA的逻辑回归系数构建的LVO评分对CTA上LVO的存在显示出最高的准确性（AUC为0.91）。
LVO评分可能是一种识别ACS患者LVO的有用筛查方法。
