Risk Factors for Acute Ischemic Stroke Caused by Anterior Large Vessel Occlusion.

Authors:
Philipp Hendrix
Philipp Hendrix
Saarland University Medical Center and Saarland University Faculty of Medicine
Saarbrücken | Germany
Matthew D Adams
Matthew D Adams
McMaster University
Hamilton | Canada
Ramin Zand
Ramin Zand
The International Institute of Health Studies
Canada
Thomas N Person
Thomas N Person
Center for Human Genetics
Mudit Gupta
Mudit Gupta
University of Michigan Medical School
United States

Stroke 2019 May;50(5):1074-1080

From the Department of Neurosurgery (P.H., N.S., O.G., C.M.S., C.J.G.), Geisinger, Danville, PA.

Background and Purpose- Accurate prediction of acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) that is amendable to mechanical thrombectomy remains a challenge. We developed and validated a prediction model for anterior circulation LVO stroke using past medical history elements present on admission and neurological examination. Methods- We retrospectively reviewed AIS patients admitted between 2009 and 2017 to 3 hospitals within a large healthcare system in the United States. Patients with occlusions of the internal carotid artery or M1 or M2 segments of the middle cerebral artery were randomly split into 2/3 derivation and 1/3 validation cohorts for development of an anterior circulation LVO prediction model and score that was further curtailed for potential use in the prehospital setting. Results- A total of 1654 AIS were reviewed, including 248 (15%) with proximal anterior circulation LVO AIS. In the derivation cohort, National Institutes of Health Stroke Scale score at the time of cerebrovascular imaging, current smoking status, type 2 diabetes mellitus, extracranial carotid, and intracranial atherosclerotic stenosis was significantly associated with anterior circulation LVO stroke. The prehospital score was curtailed to National Institutes of Health Stroke Scale score, current smoking status, and type 2 diabetes mellitus. The areas under the curve for the prediction model, prehospital score, and National Institutes of Health Stroke Scale score alone were 0.796, 0.757, and 0.725 for the derivation cohort and 0.770, 0.689, and 0.665 for the validation cohort, respectively. The Youden index J was 0.46 for a score of >6 with 84.7% sensitivity and 62.0% specificity for the prediction model. Conclusions- Previously reported LVO stroke prediction scores focus solely on elements of the neurological examination. In addition to stroke severity, smoking, diabetes mellitus, extracranial carotid, and intracranial atherosclerotic stenosis were associated with anterior circulation LVO AIS. Although atherosclerotic stenosis may not be known until imaging is obtained, smoking and diabetes mellitus history can be readily obtained in the field and represent important elements of the prehospital score supplementing National Institutes of Health Stroke Scale score.

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Source
https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023917
Publisher Site
http://dx.doi.org/10.1161/STROKEAHA.118.023917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509557PMC
May 2019
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