Matsukawa Hidetoshi, Chen Huanwen, Elawady Sameh Samir, Cunningham Conor, Uchida Kazutaka, Sowlat Mohammad-Mahdi, Maier Ilko, Jabbour Pascal, Kim Joon-Tae, Wolfe Stacey Quintero, Rai Ansaar, Starke Robert M, Psychogios Marios-Nikos, Samaniego Edgar A, Arthur Adam, Yoshimura Shinichi, Cuellar Hugo, Grossberg Jonathan A, Alawieh Ali, Romano Daniele G, Tanweer Omar, Mascitelli Justin, Fragata Isabel, Polifka Adam, Osbun Joshua, Crosa Roberto, Matouk Charles, Park Min S, Levitt Michael R, Brinjikji Waleed, Moss Mark, Williamson Richard, Navia Pedro, Kan Peter, De Leacy Reade, Chowdhry Shakeel, Ezzeldin Mohamad, Spiotta Alejandro M
Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
Neurosurgery. 2024 Oct 11. doi: 10.1227/neu.0000000000003220.
We aimed to develop and validate a prediction score for futile recanalization (FR) for large vessel occlusion (LVO) presenting low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) for patients who underwent endovascular thrombectomy (EVT).
Patients with anterior circulation LVO with low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score ≥2b) from Stroke Thrombectomy and Aneurysm Registry were retrospectively analyzed. FR was defined as 90-day modified Rankin Scale (mRS) scores ≥4 despite successful EVT. Multivariable logistic regression was used to identify independent predictors of FR, and they were used to create a clinical score. The performance of the score was assessed by receiver operating characteristic curve analyses.
Of 219 patients, 170 and 49 patients were randomly assigned to the training and validation cohort, respectively. Independent predictors of FR identified in the training cohort were used to construct the SNAP score: site of occlusion (middle cerebral artery = 0, internal carotid artery = 1), National Institutes of Health Stroke Scale score at admission (≤10 = 0, 10 to 19 = 1, ≥20 = 2), age (<75 = 0, ≥75 = 2), and prestroke mRS score (0-3). Receiver operating characteristic curve analyses of the SNAP score in the training and validation cohorts showed areas under the curve of 0.79 (95% CI 0.72-0.86) and 0.79 (95% CI 0.65-0.92) for predicting FR, respectively. A SNAP score ≥5 had a positive predictive value of 92.1% [95% CI 78.8%-97.3%] for FR.
The SNAP score may be useful in predicting FR after EVT in low-ASPECTS patients with LVO. It can provide patients, family members, and physicians with reliable outcome expectations among patients with acute ischemic stroke with large infarcts.
我们旨在为接受血管内血栓切除术（EVT）的、表现为低阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）的大血管闭塞（LVO）患者开发并验证一种无效再通（FR）预测评分。
对来自卒中血栓切除术和动脉瘤登记处的、接受成功EVT（改良脑缺血治疗评分≥2b）的前循环LVO且ASPECTS较低（<6）的患者进行回顾性分析。FR定义为尽管EVT成功，但90天改良Rankin量表（mRS）评分≥4。采用多变量逻辑回归来识别FR的独立预测因素，并将其用于创建临床评分。通过受试者工作特征曲线分析评估该评分的性能。
219例患者中，分别有170例和49例患者被随机分配至训练队列和验证队列。在训练队列中识别出的FR独立预测因素用于构建SNAP评分：闭塞部位（大脑中动脉=0，颈内动脉=1）、入院时美国国立卫生研究院卒中量表评分（≤10=0，10至19=1，≥20=2）、年龄（<75=0，≥75=2）和卒中前mRS评分（0 - 3）。训练队列和验证队列中SNAP评分的受试者工作特征曲线分析显示，预测FR时曲线下面积分别为0.79（95%CI 0.72 - 0.86）和0.79（95%CI 0.65 - 0.92）。SNAP评分≥5对FR的阳性预测值为92.1%[95%CI 78.8% - 97.3%]。
SNAP评分可能有助于预测低ASPECTS的LVO患者EVT后的FR。它可为急性缺血性卒中伴大面积梗死患者的患者、家属和医生提供可靠的预后预期。
