Derivation and validation of a predictive scale to expedite endovascular intervention for acute stroke patients with an intervenable vessel occlusion

Zeguang Ren; Runqi Wangqin; Francis Demiraj; Weizhe Li; Maxim Mokin; Anxin Wang; Zhongrong Miao; Yongjun Wang; W Scott Burgin

doi:10.1136/jnis-2023-020871

Derivation and validation of a predictive scale to expedite endovascular intervention for acute stroke patients with an intervenable vessel occlusion

J Neurointerv Surg. 2023 Sep 21:jnis-2023-020871. doi: 10.1136/jnis-2023-020871. Online ahead of print.

Authors

Zeguang Ren¹, Runqi Wangqin², Francis Demiraj³, Weizhe Li⁴, Maxim Mokin⁵, Anxin Wang⁶, Zhongrong Miao⁷, Yongjun Wang⁸, W Scott Burgin⁹

Affiliations

¹ Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China wburgin@usf.edu renzem@gmail.com.
² Duke Clinical Research Institute, Duke Univeristy Medical Center, Durham, North Carolina, USA.
³ Department of Neurology, FAU Schmidt College of Medicine, Boca Raton, Florida, USA.
⁴ Department of Neurology, Duke University, Durham, North Carolina, USA.
⁵ Department of Neurosurgery and Neurology, University of South Florida, Tampa, Florida, USA.
⁶ China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China.
⁷ Department of Neurological Intervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁸ China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.
⁹ Department of Neurology, University of South Florida, Tampa, Florida, USA wburgin@usf.edu renzem@gmail.com.

PMID: 37734930
DOI: 10.1136/jnis-2023-020871

Abstract

Background: Early endovascular intervention team mobilization may reduce reperfusion times and improve clinical outcomes for patients with acute ischemic stroke (AIS) with a possible intervenable vessel occlusion (IVO). In an emergency department or mobile stroke unit, incorporating rapidly available non-contrast CT (NCCT) information with examination findings may improve the accuracy of arterial occlusion prediction scales. For this purpose, we developed a rapid and straightforward IVO predictive instrument-the T³AM²PA¹ scale.

Methods: The T³AM²PA¹ scale was retrospectively derived from our 'Get with the Guidelines' database. We included all patients with acute stroke alert between January 2017 and August 2018 with a National Institutes of Health Stroke Scale (NIHSS) score between 5 and 25 inclusive. Different pre-intervention variables were collected, including itemized NIHSS and NCCT information. The T³AM²PA¹ scale was also compared with other commonly used scales and was validated in a separate sequential retrospective cohort of patients with a full range of NIHSS scores.

Results: 574 eligible patients from 2115 acute stroke alerts were identified. The scale was established with five items (CT hyperdense sign, parenchymal hypodensity, lateralizing hemiparesis, gaze deviation, and language disturbance), with a total score of 9. To minimize unnecessary angiography, a cut-off of ≥5 for IVO detection yielded a sensitivity of 52%, a specificity of 90%, and a positive predictive value of 76%.

Conclusions: The T³AM²PA¹ scale accurately predicts the presence of clinical IVO in patients with AIS. Adopting the T³AM²PA¹ scale could reduce revascularization times, improve treatment outcomes, and potentially reduce disability.

Keywords: stroke; thrombectomy.