Cheng Zhe, Geng Xiaokun, Rajah Gary B, Gao Jie, Ma Linlin, Li Fenghai, Du Huishan, Ding Yuchuan
1Department of Neurology and Stroke Center, Luhe Hospital, Capital Medical University, Beijing, China.
2China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China.
Aging Dis. 2021 Apr 1;12(2):415-424. doi: 10.14336/AD.2020.0709. eCollection 2021 Apr.
Although revascularization rates after endovascular thrombectomy for large vessel acute ischemic stroke (AIS) are high (71%), only 46% of patients achieve functional independence at 90 days. The present study was designed to explore a new method for predicting the functional prognosis of AIS patients after endovascular recanalization. A total of 200 anterior circulation stroke patients who received endovascular therapy were enrolled. Logistic regression analysis of clinical characteristics on functional independence were performed. The predictive power of sub-items in National Institute of Health stroke scale (NIHSS) and the combination of NIHSS consciousness and Alberta Stroke Program Early CT Score (ASPECTS) on functional independence were assessed by Receiver Operating Characteristic (ROC) curves and the latter was compared with 3 previously published prediction models by AUC (the area under ROC curve). The AUC for the NIHSS consciousness score to predict functional independence was higher than whole NIHSS and other sub-items (0.716 v 0.705, 0.586, 0.573, 0.552 and 0.559). Low NIHSS consciousness score, high ASPECTS score, short time from onset to recanalization, and high rate of successful recanalization were demonstrated to be significantly associated with the functional independence (OR 0.697, 2.226, 0.994 and 28.643). The prediction power of the combination was significantly better than NIHSS and ASPECTS alone (AUC 0.793 v 0.705 and 0.752). Compared with 3 other prediction models, the combination was found to be the strongest predictor for functional independence (AUC 0.793 v 0.791, 0.671 and 0.564). NIHSS which has been shown to be a strong predictor of functional outcomes after endovascular recanalization is largely dependent on the consciousness component. NIHSS consciousness score combined with ASPECTS appears to be a favorable predictor of functional independence. These findings may have broad reaching effects for isolated centers around the world without advanced imaging for triage and prognostication.
尽管大血管急性缺血性卒中（AIS）血管内血栓切除术的血管再通率很高（71%），但只有46%的患者在90天时实现功能独立。本研究旨在探索一种预测AIS患者血管内再通后功能预后的新方法。共纳入200例接受血管内治疗的前循环卒中患者。对功能独立的临床特征进行逻辑回归分析。通过受试者操作特征（ROC）曲线评估美国国立卫生研究院卒中量表（NIHSS）各子项以及NIHSS意识与阿尔伯塔卒中项目早期CT评分（ASPECTS）联合对功能独立的预测能力，并将后者与3个先前发表的预测模型通过ROC曲线下面积（AUC）进行比较。NIHSS意识评分预测功能独立的AUC高于整个NIHSS及其他子项（0.716对0.705、0.586、0.573、0.552和0.559）。低NIHSS意识评分、高ASPECTS评分、从发病到再通的时间短以及高成功再通率被证明与功能独立显著相关（比值比分别为0.697、2.226、0.994和28.643）。联合预测能力明显优于单独的NIHSS和ASPECTS（AUC分别为0.793对0.705和0.752）。与其他3个预测模型相比，联合模型被发现是功能独立的最强预测指标（AUC分别为0.793对0.791、0.671和0.564）。已被证明是血管内再通后功能结局强预测指标的NIHSS在很大程度上依赖于意识成分。NIHSS意识评分与ASPECTS联合似乎是功能独立的良好预测指标。这些发现可能对世界各地没有先进影像用于分诊和预后评估的独立中心产生广泛影响。
