Journal article
Clinically Approximated Hypoperfused Tissue in Large Vessel Occlusion Stroke
Stroke (1970), Vol.52(6), pp.2109-2114
06/01/2021
DOI: 10.1161/STROKEAHA.120.033294
PMID: 33971743
Abstract
BACKGROUND AND PURPOSE: Patient selection for thrombectomy of acute ischemic stroke caused by large vessel occlusion in the delayed time window (>6 hours) is dependent on delineation of clinical-core mismatch or radiological target mismatch using perfusion imaging. Selection paradigms not involving advanced imaging and software processing may reduce time to treatment and broaden eligibility. We aim to develop a conversion factor to approximately determine the volume of hypoperfused tissue using the National Institutes of Health Stroke Scale (NIHSS) score (clinically approximated hypoperfused tissue [CAT] volume) and explore its ability to identify patients eligible for thrombectomy in the late-time window.
METHODS: We performed a retrospective analysis of anterior circulation large vessel occlusion strokes at 3 comprehensive stroke centers. Demographic, clinical, and imaging (computed tomography perfusion processed using RAPID, IschemaView) information was analyzed. A conversion factor, which is a multiple of the NIHSS score (for NIHSS score <10 and >= 10), was derived from an initial cohort to calculate CAT volumes. Accuracy of CAT-based thrombectomy eligibility criteria (using CAT volume instead of Tmax >6 seconds volume) was tested using DEFUSE-3 criteria (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) eligibility as a gold standard in an independent cohort.
RESULTS: Of the 309 large vessel occlusion strokes (age, 70 +/- 14, 46% male, median NIHSS 16 [12-20]) included in this study, 38% of patients arrived beyond 6 hours of time from last known well. Conversion factors derived (derivation cohort-center A: 187) based on median values of Tmax>6 second volume for NIHSS score <10 subgroup was 15 and for NIHSS score >= 10 subgroup was 6. Subsequently calculated CAT volume-based eligibility criteria yielded a sensitivity of 100% and specificity of 92% in detecting DEFUSE-3 eligible patients (area under the curve, 0.92 [95% CI, 0.82-1]) in the validation cohort (center B and C:122).
CONCLUSIONS: Clinical severity of stroke (NIHSS score) may be used to calculate the volume of hypoperfused tissue during large vessel occlusion stroke. CAT volumes for NIHSS score <10 (using a factor of 15) and >= 10 (using a factor of 6) subgroups can accurately identify DEFUSE-3-eligible patients.
Details
- Title: Subtitle
- Clinically Approximated Hypoperfused Tissue in Large Vessel Occlusion Stroke
- Creators
- Shashvat M. Desai - Department of Neurology (S.M.D., A.P.J.), University of Pittsburgh Medical Center, PA.Santiago Ortega-Gutierrez - University of IowaSunil A. Sheth - Lohmann & Rauscher (Germany)Mudassir Farooqui - University of IowaVictor Lopez-Rivera - Department of Neurology, UTHealth McGovern Medical School, Houston, TX (S.A.S., V.L.-R., S.S.-M., R.A.).Cynthia Zevallos - University of IowaSergio Salazar-Marioni - Department of Neurology, UTHealth McGovern Medical School, Houston, TX (S.A.S., V.L.-R., S.S.-M., R.A.).Darko Quispe-Orozco - University of IowaRania Abdelkhaliq - UTHlth McGovern Med Sch, Dept Neurol, Houston, TX USADaniel A. Tonetti - University of Pittsburgh Medical CenterTudor G. Jovin - Cooper University HospitalAshutosh P. Jadhav - Department of Neurology (S.M.D., A.P.J.), University of Pittsburgh Medical Center, PA.
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.52(6), pp.2109-2114
- DOI
- 10.1161/STROKEAHA.120.033294
- PMID
- 33971743
- NLM abbreviation
- Stroke
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 6
- Language
- English
- Date published
- 06/01/2021
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984302209902771
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