Ligot Noémie, Dagonnier Marie, Lubicz Boris, Brassart Nicolas, Naeije Gilles
Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Department of Neurology, CHU HELORA-Kennedy, Mons, Belgium.
Front Neurol. 2025 Jul 7;16:1578997. doi: 10.3389/fneur.2025.1578997. eCollection 2025.
Mechanical thrombectomy (MT) is a proven intervention for patients with acute ischemic stroke (AIS) due to a large vessel occlusion (LVO). However, outcomes after MT remain variable, particularly in high-risk groups. The SPAN-100 index, a simple bedside tool combining age and baseline NIHSS scores, has been associated with poor outcomes in AIS patients treated with intravenous thrombolysis. This study evaluates the prognostic value of the SPAN-100 index and its weighted variant (wSPAN) in predicting outcomes following MT.
We conducted a retrospective cohort study of patients with AIS who were treated with MT between 2015 and 2024 at two Belgian university hospitals. SPAN and wSPAN scores were calculated at admission, and patients were stratified by SPAN ≥100 vs. <100. The primary outcome was functional status at 90 days, as assessed using the modified Rankin Scale (mRS). Secondary outcomes included mortality (mRS = 6) and favorable outcomes (mRS ≤ 3). Discriminative ability was assessed using receiver operating characteristic (ROC) analysis (AUC, 95% CI), and model performance was evaluated using AIC and BIC. The positive predictive value (PPV) and negative predictive value (NPV) were calculated for SPAN ≥100, and outcome proportions were compared between SPAN-defined groups using Fisher's exact test.
A total of 530 patients were included, of whom 116 had SPAN scores of ≥100. These patients experienced significantly worse outcomes, with higher mortality (60.0% vs. 17.6%) and lower rates of mRS ≤ 3 (19.2% vs. 71.6%, both -values < 0.001). However, among survivors with SPAN scores of ≥100, nearly half of them achieved recovery (mRS ≤ 3). ROC analysis showed good discrimination for both SPAN and wSPAN: AUCs were 0.77 and 0.78 for mRS ≤ 3 and 0.80 and 0.81 for mortality. wSPAN showed a slightly better model fit (lower AIC/BIC). The SPAN ≥100 threshold had a high PPV for poor outcomes and a high NPV for survival.
SPAN-100 and wSPAN are pragmatic and reliable prognostic tools for AIS patients undergoing MT. While a SPAN score ≥100 identifies a high-risk group with poorer overall outcomes, it should not be used as an exclusion criterion. Many patients with a SPAN score ≥100 achieved functional recovery, supporting MT as a justified intervention even for older, more severely affected individuals. These findings highlight the importance of combining risk stratification with clinical judgment rather than relying on rigid thresholds.
机械取栓术（MT）是治疗因大血管闭塞（LVO）导致的急性缺血性卒中（AIS）患者的一种经证实的干预措施。然而，MT后的结局仍存在差异，尤其是在高危人群中。SPAN - 100指数是一种结合年龄和基线美国国立卫生研究院卒中量表（NIHSS）评分的简单床边工具，已被证明与接受静脉溶栓治疗的AIS患者预后不良有关。本研究评估SPAN - 100指数及其加权变体（wSPAN）在预测MT后结局方面的预后价值。
我们对2015年至2024年期间在两家比利时大学医院接受MT治疗的AIS患者进行了一项回顾性队列研究。入院时计算SPAN和wSPAN评分，并根据SPAN≥100与<100对患者进行分层。主要结局是90天时的功能状态，采用改良Rankin量表（mRS）进行评估。次要结局包括死亡率（mRS = 6）和良好结局（mRS≤3）。使用受试者操作特征（ROC）分析（AUC，95%CI）评估判别能力，并使用AIC和BIC评估模型性能。计算SPAN≥100的阳性预测值（PPV）和阴性预测值（NPV），并使用Fisher精确检验比较SPAN定义组之间的结局比例。
共纳入530例患者，其中116例SPAN评分≥100。这些患者的结局明显更差，死亡率更高（60.0%对17.6%），mRS≤3的比例更低（19.2%对71.6%，P值均<0.001）。然而，在SPAN评分≥100的幸存者中，近一半实现了恢复（mRS≤3）。ROC分析显示SPAN和wSPAN均具有良好的判别能力：对于mRS≤3，AUC分别为0.77和0.78；对于死亡率，AUC分别为0.80和0.81。wSPAN显示出稍好的模型拟合度（较低的AIC/BIC）。SPAN≥100阈值对不良结局具有较高的PPV，对生存具有较高的NPV。
SPAN - 100和wSPAN是接受MT治疗的AIS患者实用且可靠的预后工具。虽然SPAN评分≥100可识别出总体结局较差的高危人群，但不应将其用作排除标准。许多SPAN评分≥100的患者实现了功能恢复，这支持MT即使对于年龄较大、病情更严重的个体也是一种合理的干预措施。这些发现强调了将风险分层与临床判断相结合的重要性，而不是依赖于严格的阈值。
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