Pittsburgh outcomes after stroke thrombectomy score predicts outcomes after endovascular therapy for anterior circulation large vessel occlusions

Srikant Rangaraju, John T P Liggins, Amin Aghaebrahim, Christopher Streib, Chung Huan Sun, Rishi Gupta, Raul Nogueira, Michael Frankel, Michael Mlynash, Maarten Lansberg, Gregory Albers, Ashutosh Jadhav, Tudor G. Jovin

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17 Scopus citations

Abstract

BACKGROUND AND PURPOSE - : Prognostication tools that predict good outcome in patients with anterior circulation large vessel occlusions after endovascular therapy are lacking. We aim to develop a tool that incorporates clinical and imaging data to predict outcomes after endovascular therapy. METHODS - : In a derivation cohort of anterior circulation large vessel occlusion stroke patients treated with endovascular therapy within 8 hours from time last seen well (n=247), we performed logistic regression to identify independent predictors of good outcome (90-day modified Rankin Scale, 0-2). Factors were weighted based on β-coefficients to derive the Pittsburgh Outcomes After Stroke Thrombectomy (POST) score. POST was validated in an institutional endovascular database (University of Pittsburgh Medical Center, n=393) and the Diffusion-Weighted Imaging Evaluation for Understanding Stroke Evolution Study-2 (DEFUSE-2) data set (n=105), as well as in patients treated beyond 8 hours (n=194) and in octogenarians (n=111). RESULTS - : In the derivation cohort, independent predictors (P<0.1) of good outcome included 24- to 72-hour final infarct volume (in cm, P<0.001), age (years, P<0.001), and parenchymal hematoma types 1 and 2 (H, P=0.01). POST was calculated as age+0.5×final infarct volume+15×H. Patients with POST score <60 had a 91% chance of good outcome compared with 4% with POST score ≥120. POST accurately predicted good outcomes in the derivation (area under the curve [AUC]=0.85) and validation cohorts (University of Pittsburgh Medical Center, AUC=0.81; DEFUSE-2, AUC=0.86), as well as in patients treated beyond 8 hours (AUC, 0.85) and octogenarians (AUC=0.76). POST had better predictive accuracy for good and poor outcome than the ischemic stroke predictive risk score (iSCORE). CONCLUSIONS - : POST score is a validated predictor of outcome in patients with anterior circulation large vessel occlusions after endovascular therapy.

Original languageEnglish (US)
Pages (from-to)2298-2304
Number of pages7
JournalStroke
Volume45
Issue number8
DOIs
StatePublished - Aug 2014

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Keywords

  • cerebrovascular occlusion
  • endovascular procedures
  • infarction
  • ischemia
  • prognosis
  • stroke
  • thrombectomy

Cite this

Rangaraju, S., Liggins, J. T. P., Aghaebrahim, A., Streib, C., Sun, C. H., Gupta, R., Nogueira, R., Frankel, M., Mlynash, M., Lansberg, M., Albers, G., Jadhav, A., & Jovin, T. G. (2014). Pittsburgh outcomes after stroke thrombectomy score predicts outcomes after endovascular therapy for anterior circulation large vessel occlusions. Stroke, 45(8), 2298-2304. https://doi.org/10.1161/STROKEAHA.114.005595