ASTRAL-R score predicts non-recanalisation after intravenous thrombolysis in acute ischaemic stroke.

Détails

ID Serval
serval:BIB_0C0F029B0DAD
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
ASTRAL-R score predicts non-recanalisation after intravenous thrombolysis in acute ischaemic stroke.
Périodique
Thrombosis and Haemostasis
Auteur⸱e⸱s
Vanacker P., Heldner M.R., Seiffge D., Mueller H., Eskandari A., Traenka C., Ntaios G., Mosimann P.J., Sztajzel R., Mendes Pereira V., Cras P., Engelter S., Lyrer P., Fischer U., Lambrou D., Arnold M., Michel P.
ISSN
0340-6245 (Print)
ISSN-L
0340-6245
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
113
Numéro
5
Pages
1121-1126
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Intravenous thrombolysis (IVT) as treatment in acute ischaemic strokes may be insufficient to achieve recanalisation in certain patients. Predicting probability of non-recanalisation after IVT may have the potential to influence patient selection to more aggressive management strategies. We aimed at deriving and internally validating a predictive score for post-thrombolytic non-recanalisation, using clinical and radiological variables. In thrombolysis registries from four Swiss academic stroke centres (Lausanne, Bern, Basel and Geneva), patients were selected with large arterial occlusion on acute imaging and with repeated arterial assessment at 24 hours. Based on a logistic regression analysis, an integer-based score for each covariate of the fitted multivariate model was generated. Performance of integer-based predictive model was assessed by bootstrapping available data and cross validation (delete-d method). In 599 thrombolysed strokes, five variables were identified as independent predictors of absence of recanalisation: Acute glucose > 7 mmol/l (A), significant extracranial vessel STenosis (ST), decreased Range of visual fields (R), large Arterial occlusion (A) and decreased Level of consciousness (L). All variables were weighted 1, except for (L) which obtained 2 points based on β-coefficients on the logistic scale. ASTRAL-R scores 0, 3 and 6 corresponded to non-recanalisation probabilities of 18, 44 and 74 % respectively. Predictive ability showed AUC of 0.66 (95 %CI, 0.61-0.70) when using bootstrap and 0.66 (0.63-0.68) when using delete-d cross validation. In conclusion, the 5-item ASTRAL-R score moderately predicts non-recanalisation at 24 hours in thrombolysed ischaemic strokes. If its performance can be confirmed by external validation and its clinical usefulness can be proven, the score may influence patient selection for more aggressive revascularisation strategies in routine clinical practice.
Mots-clé
Algorithms, Area Under Curve, Brain Ischemia/drug therapy, Decision Support Systems, Clinical, Fibrinolytic Agents/therapeutic use, Humans, Predictive Value of Tests, Prospective Studies, ROC Curve, Regression Analysis, Severity of Illness Index, Stroke/drug therapy, Thrombolytic Therapy/adverse effects, Thrombolytic Therapy/methods, Treatment Outcome
Pubmed
Web of science
Création de la notice
17/04/2015 17:39
Dernière modification de la notice
20/08/2019 13:33
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