Journal
STROKE
Volume 44, Issue 12, Pages 3324-3330Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.113.001050
Keywords
acute ischemic stroke; HIAT2; intra-arterial therapy; prediction scores; thrombolysis
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Funding
- National institutes of Health (NIH) [NIH 5 T32 NS007412-12, P50 NS 044227]
- Clinical and Translational Award [UL1 RR024148 (TL1 RR024147), KL2 RR0224149]
- AHRQ [5 T32 HS013852-10]
- National Institute on Minority Health and Health Disparities (NIMHD), NIH [3 P60 MD000502-08S1]
- American Heart Association [13PRE13830003]
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Background and Purpose Intra-arterial therapy (IAT) promotes recanalization of large artery occlusions in acute ischemic stroke. Despite high recanalization rates, poor clinical outcomes are common. We attempted to optimize a score that combines clinical and imaging variables to more accurately predict poor outcome after IAT in anterior circulation occlusions. Methods Patients with acute ischemic stroke undergoing IAT at University of Texas (UT) Houston for large artery occlusions (middle cerebral artery or internal carotid artery) were reviewed. Independent predictors of poor outcome (modified Rankin Scale, 4-6) were studied. External validation was performed on IAT-treated patients at Emory University. Results A total of 163 patients were identified at UT Houston. Independent predictors of poor outcome (P0.2) were identified as score variables using sensitivity analysis and logistic regression. Houston Intra-Arterial Therapy 2 (HIAT2) score ranges 0 to 10: age (59=0, 60-79=2, 80 years=4), glucose (<150=0, 150=1), National Institute Health Stroke Scale (10=0, 11-20=1, 21=2), the Alberta Stroke Program Early CT Score (8-10=0, 7=3). Patients with HIAT25 were more likely to have poor outcomes at discharge (odds ratio, 6.43; 95% confidence interval, 2.75-15.02; P<0.001). After adjusting for reperfusion (Thrombolysis in Cerebral Infarction score 2b) and time from symptom onset to recanalization, HIAT25 remained an independent predictor of poor outcome (odds ratio, 5.88; 95% confidence interval, 1.96-17.64; P=0.02). Results from the cohort of Emory (198 patients) were consistent; patients with HIAT2 score 5 had 6x greater odds of poor outcome at discharge and at 90 days. HIAT2 outperformed other previously published predictive scores. Conclusions The HIAT2 score, which combines clinical and imaging variables, performed better than all previous scores in predicting poor outcome after IAT for anterior circulation large artery occlusions.
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