From the Department of Neurosurgery (P.H., N.S., O.G., C.M.S., C.J.G.), Geisinger, Danville, PA.
Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany (P.H.).
Stroke. 2019 May;50(5):1074-1080. doi: 10.1161/STROKEAHA.118.023917.
Background and Purpose- Accurate prediction of acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) that is amendable to mechanical thrombectomy remains a challenge. We developed and validated a prediction model for anterior circulation LVO stroke using past medical history elements present on admission and neurological examination. Methods- We retrospectively reviewed AIS patients admitted between 2009 and 2017 to 3 hospitals within a large healthcare system in the United States. Patients with occlusions of the internal carotid artery or M1 or M2 segments of the middle cerebral artery were randomly split into 2/3 derivation and 1/3 validation cohorts for development of an anterior circulation LVO prediction model and score that was further curtailed for potential use in the prehospital setting. Results- A total of 1654 AIS were reviewed, including 248 (15%) with proximal anterior circulation LVO AIS. In the derivation cohort, National Institutes of Health Stroke Scale score at the time of cerebrovascular imaging, current smoking status, type 2 diabetes mellitus, extracranial carotid, and intracranial atherosclerotic stenosis was significantly associated with anterior circulation LVO stroke. The prehospital score was curtailed to National Institutes of Health Stroke Scale score, current smoking status, and type 2 diabetes mellitus. The areas under the curve for the prediction model, prehospital score, and National Institutes of Health Stroke Scale score alone were 0.796, 0.757, and 0.725 for the derivation cohort and 0.770, 0.689, and 0.665 for the validation cohort, respectively. The Youden index J was 0.46 for a score of >6 with 84.7% sensitivity and 62.0% specificity for the prediction model. Conclusions- Previously reported LVO stroke prediction scores focus solely on elements of the neurological examination. In addition to stroke severity, smoking, diabetes mellitus, extracranial carotid, and intracranial atherosclerotic stenosis were associated with anterior circulation LVO AIS. Although atherosclerotic stenosis may not be known until imaging is obtained, smoking and diabetes mellitus history can be readily obtained in the field and represent important elements of the prehospital score supplementing National Institutes of Health Stroke Scale score.
背景与目的——准确预测可通过机械取栓治疗的急性缺血性卒中（AIS）所致的前循环大血管闭塞（LVO）仍然是一项挑战。我们利用入院时的既往病史和神经系统检查的元素开发并验证了一种用于前循环 LVO 卒中的预测模型。
方法——我们回顾性分析了 2009 年至 2017 年期间在美国一个大型医疗保健系统内的 3 家医院就诊的 AIS 患者。颈内动脉或大脑中动脉 M1 或 M2 段闭塞的患者被随机分为 2/3 的推导队列和 1/3 的验证队列，以开发前循环 LVO 预测模型和评分，并进一步缩短用于院前环境的评分。
结果——共回顾了 1654 例 AIS，其中 248 例（15%）为近端前循环 LVO AIS。在推导队列中，脑血管成像时的国立卫生研究院卒中量表评分、当前吸烟状态、2 型糖尿病、颅外颈动脉和颅内动脉粥样硬化狭窄与前循环 LVO 卒中显著相关。院前评分被简化为国立卫生研究院卒中量表评分、当前吸烟状态和 2 型糖尿病。预测模型、院前评分和国立卫生研究院卒中量表评分的曲线下面积在推导队列中分别为 0.796、0.757 和 0.725，在验证队列中分别为 0.770、0.689 和 0.665。得分>6 的约登指数 J 为 0.46，预测模型的敏感性为 84.7%，特异性为 62.0%。
结论——先前报道的 LVO 卒中预测评分仅关注神经系统检查的元素。除了卒中严重程度外，吸烟、糖尿病、颅外颈动脉和颅内动脉粥样硬化狭窄与前循环 LVO AIS 相关。尽管在获得影像学检查之前可能不知道动脉粥样硬化狭窄，但可以在现场轻松获得吸烟和糖尿病病史，这些病史是补充国立卫生研究院卒中量表评分的院前评分的重要元素。
