TY - JOUR
T1 - Improving patient selection for endovascular treatment of acute cerebral ischemia
T2 - a review of the literature and an external validation of the Houston IAT and THRIVE predictive scoring systems
AU - Ishkanian, Amy A.
AU - McCullough-Hicks, Margy E.
AU - Appelboom, Geoffrey
AU - Piazza, Matthew A.
AU - Hwang, Brian Y.
AU - Bruce, Samuel S.
AU - Hannan, Lindsay M.
AU - Sander Connolly, E.
AU - Lavine, Sean D.
AU - Meyers, Philip M.
PY - 2011/6
Y1 - 2011/6
N2 - Outcome after intraarterial therapy (IAT) for acute ischemic stroke remains variable, suggesting that improved patient selection is needed to better identify patients likely to benefit from treatment. The authors evaluate the predictive accuracies of the Houston IAT (HIAT) and the Totaled Health Risks in Vascular Events (THRIVE) scores in an independent cohort and review the existing literature detailing additional predictive factors to be used in patient selection for IAT. They reviewed their center's endovascular records from January 2004 to July 2010 and identified patients who had acute ischemic stroke and underwent IAT. They calculated individual HIAT and THRIVE scores using patient age, admission National Institutes of Health Stroke Scale (NIHSS) score, admission glucose level, and medical history. The scores' predictive accuracies for good outcome (discharge modified Rankin Scale score ≤ 3) were analyzed using receiver operating characteristics analysis. The THRIVE score predicts poor outcome after IAT with reasonable accuracy and may perform better than the HIAT score. Nevertheless, both measures may have significant clinical utility; further validation in larger cohorts that accounts for differences in patient demographic characteristics, variation in time-to-treatment, and center preferences with respect to IAT modalities is needed. Additional patient predictive factors have been reported but not yet incorporated into predictive scales; the authors suggest the need for additional data analysis to determine the independent predictive value of patient admission NIHSS score, age, admission hyperglycemia, patient comorbidities, thrombus burden, collateral flow, time to treatment, and baseline neuroimaging findings.
AB - Outcome after intraarterial therapy (IAT) for acute ischemic stroke remains variable, suggesting that improved patient selection is needed to better identify patients likely to benefit from treatment. The authors evaluate the predictive accuracies of the Houston IAT (HIAT) and the Totaled Health Risks in Vascular Events (THRIVE) scores in an independent cohort and review the existing literature detailing additional predictive factors to be used in patient selection for IAT. They reviewed their center's endovascular records from January 2004 to July 2010 and identified patients who had acute ischemic stroke and underwent IAT. They calculated individual HIAT and THRIVE scores using patient age, admission National Institutes of Health Stroke Scale (NIHSS) score, admission glucose level, and medical history. The scores' predictive accuracies for good outcome (discharge modified Rankin Scale score ≤ 3) were analyzed using receiver operating characteristics analysis. The THRIVE score predicts poor outcome after IAT with reasonable accuracy and may perform better than the HIAT score. Nevertheless, both measures may have significant clinical utility; further validation in larger cohorts that accounts for differences in patient demographic characteristics, variation in time-to-treatment, and center preferences with respect to IAT modalities is needed. Additional patient predictive factors have been reported but not yet incorporated into predictive scales; the authors suggest the need for additional data analysis to determine the independent predictive value of patient admission NIHSS score, age, admission hyperglycemia, patient comorbidities, thrombus burden, collateral flow, time to treatment, and baseline neuroimaging findings.
KW - Acute cerebral ischemia
KW - Futile recanalization
KW - Intraarterial therapy
KW - Patient selection
KW - Predictive scale validation
KW - Vascular disorders
UR - http://www.scopus.com/inward/record.url?scp=79958830573&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79958830573&partnerID=8YFLogxK
U2 - 10.3171/2011.3.FOCUS1144
DO - 10.3171/2011.3.FOCUS1144
M3 - Article
C2 - 21631231
AN - SCOPUS:79958830573
SN - 1092-0684
VL - 30
JO - Neurosurgical focus
JF - Neurosurgical focus
IS - 6
M1 - E7
ER -