Neuroradiology, Centre Hospitalier Sainte Anne, Paris, France.
Radiology, Centro-hospitalo Universitaire de Poitiers, Poitiers, France.
J Neurointerv Surg. 2020 Mar;12(3):246-251. doi: 10.1136/neurintsurg-2019-015105. Epub 2019 Aug 19.
The MRI-DRAGON score includes clinical and MRI parameters and demonstrates a high specificity in predicting 3 month outcome in patients with acute ischemic stroke (AIS) treated with intravenous tissue plasminogen activator (IV tPA). The aim of this study was to adapt this score to mechanical thrombectomy (MT) in a large multicenter cohort.
Consecutive cases of AIS treated by MT between January 2015 and December 2017 from three stroke centers were reviewed (n=1077). We derived the MT-DRAGON score by keeping all variables of the MRI-DRAGON score (age, initial National Institutes of Health Stroke Scale score, glucose level, pre-stroke modified Rankin Scale (mRS) score, diffusion weighted imaging-Alberta Stroke Program Early CT score ≤5) and considering the following variables: time to groin puncture instead of onset to IV tPA time and occlusion site. Unfavorable 3 month outcome was defined as a mRS score >2. Score performance was evaluated by c statistics and an external validation was performed.
Among 679 included patients (derivation and validation cohorts, n=431 and 248, respectively), an unfavorable outcome was similar between the derivation (51.5%) and validation (58.1%, P=0.7) cohorts, and was significantly associated with all MT-DRAGON parameters in the multivariable analysis. The c statistics for unfavorable outcome prediction was 0.83 (95%CI 0.79 to 0.88) in the derivation and 0.8 (95%CI 0.75 to 0.86) in the validation cohort. All patients (n=55) with an MT-DRAGONscore ≥11 had an unfavorable outcome and 60/63 (95%) patients with an MT-DRAGON score ≤2 points had a favorable outcome.
The MT-DRAGON score is a simple tool, combining admission clinical and radiological parameters that can reliably predict 3 month outcome after MT.
MRI-DRAGON 评分包含临床和 MRI 参数，在预测接受静脉组织型纤溶酶原激活剂（IV tPA）治疗的急性缺血性脑卒中（AIS）患者 3 个月结局方面具有高特异性。本研究旨在将该评分应用于大型多中心机械取栓（MT）队列。
回顾性分析 2015 年 1 月至 2017 年 12 月 3 个卒中中心接受 MT 治疗的 AIS 连续病例（n=1077）。我们通过保留 MRI-DRAGON 评分的所有变量（年龄、初始国立卫生研究院卒中量表评分、血糖水平、卒中前改良 Rankin 量表评分、弥散加权成像-阿尔伯塔卒中项目早期 CT 评分≤5）并考虑以下变量得出 MT-DRAGON 评分：股动脉穿刺时间而非 IV tPA 时间至发病时间和闭塞部位。3 个月预后不良定义为改良 Rankin 量表评分>2。通过 C 统计量评估评分性能，并进行外部验证。
在纳入的 679 例患者中（推导和验证队列，n=431 和 248），推导和验证队列的不良结局发生率相似（51.5%和 58.1%，P=0.7），且在多变量分析中与所有 MT-DRAGON 参数显著相关。推导队列不良结局预测的 C 统计量为 0.83（95%CI 0.790.88），验证队列为 0.8（95%CI 0.750.86）。所有 MT-DRAGON 评分≥11 的患者（n=55）均预后不良，60/63（95%）MT-DRAGON 评分≤2 分的患者预后良好。
MT-DRAGON 评分是一种简单的工具，结合入院临床和影像学参数，可以可靠地预测 MT 后 3 个月的结局。
