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

Peter Vanacker; Mirjam R. Heldner; David Seiffge; Hubertus Mueller; Ashraf Eskandari; Christopher Traenka; George Ntaios; Pascal J. Mosimann; Roman Sztajzel; Vitor Mendes Pereira; Patrick Cras; Stefan Engelter; Philippe Lyrer; Urs Fischer; Dimitris Lambrou; Marcel Arnold; Patrik Michel

doi:10.1160/TH14-06-0482

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 113(05): 1121-1126
DOI: 10.1160/TH14-06-0482

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

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

Peter Vanacker

¹Department of Neurology, Centre Hospital Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

²Department of Neurology, General Hospital Sint-Lucas, Bruges, Belgium

³Department of Neurology, Born Bunge Institute, University and University Hospital, Antwerp, Belgium

,

Mirjam R. Heldner

⁴Department of Neurology, University Hospital, Bern, Switzerland

,

David Seiffge

⁵Department of Neurology and Stroke Center, University Hospital, Basel, Switzerland

,

Hubertus Mueller

⁶Department of Neurology, University Hospital, Geneva, Switzerland

,

Ashraf Eskandari

¹Department of Neurology, Centre Hospital Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

,

Christopher Traenka

⁵Department of Neurology and Stroke Center, University Hospital, Basel, Switzerland

,

George Ntaios

⁷Department of Medicine, University of Thessaly, Larissa, Greece

,

Pascal J. Mosimann

⁸Institute for Diagnostic and Interventional Neuroradiology, Centre Hospital Universitaire Vaudois, Lausanne, Switzerland

,

Roman Sztajzel

⁶Department of Neurology, University Hospital, Geneva, Switzerland

,

Vitor Mendes Pereira^*

⁹Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Geneva, Switzerland

,

Patrick Cras

³Department of Neurology, Born Bunge Institute, University and University Hospital, Antwerp, Belgium

,

Stefan Engelter

⁵Department of Neurology and Stroke Center, University Hospital, Basel, Switzerland

¹⁰Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation, Felix Plattee Hospital, Basel, Switzerland

,

Philippe Lyrer

⁵Department of Neurology and Stroke Center, University Hospital, Basel, Switzerland

,

Urs Fischer

⁴Department of Neurology, University Hospital, Bern, Switzerland

,

Dimitris Lambrou

¹Department of Neurology, Centre Hospital Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

,

Marcel Arnold

⁴Department of Neurology, University Hospital, Bern, Switzerland

,

Patrik Michel

¹Department of Neurology, Centre Hospital Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

› Author Affiliations

Abstract

Summary

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 integerbased 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.

Keywords

Cerebral infarction - thrombolytic therapy - decision support techniques - cerebral revascularisation - cerebrovascular occlusion

Full Text

References

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