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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
1   Department of Neurology, Centre Hospital Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
2   Department of Neurology, General Hospital Sint-Lucas, Bruges, Belgium
3   Department of Neurology, Born Bunge Institute, University and University Hospital, Antwerp, Belgium
,
Mirjam R. Heldner
4   Department of Neurology, University Hospital, Bern, Switzerland
,
David Seiffge
5   Department of Neurology and Stroke Center, University Hospital, Basel, Switzerland
,
Hubertus Mueller
6   Department of Neurology, University Hospital, Geneva, Switzerland
,
Ashraf Eskandari
1   Department of Neurology, Centre Hospital Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
,
Christopher Traenka
5   Department of Neurology and Stroke Center, University Hospital, Basel, Switzerland
,
George Ntaios
7   Department of Medicine, University of Thessaly, Larissa, Greece
,
Pascal J. Mosimann
8   Institute for Diagnostic and Interventional Neuroradiology, Centre Hospital Universitaire Vaudois, Lausanne, Switzerland
,
Roman Sztajzel
6   Department of Neurology, University Hospital, Geneva, Switzerland
,
Vitor Mendes Pereira   *
9   Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Geneva, Switzerland
,
Patrick Cras
3   Department of Neurology, Born Bunge Institute, University and University Hospital, Antwerp, Belgium
,
Stefan Engelter
5   Department of Neurology and Stroke Center, University Hospital, Basel, Switzerland
10   Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation, Felix Plattee Hospital, Basel, Switzerland
,
Philippe Lyrer
5   Department of Neurology and Stroke Center, University Hospital, Basel, Switzerland
,
Urs Fischer
4   Department of Neurology, University Hospital, Bern, Switzerland
,
Dimitris Lambrou
1   Department of Neurology, Centre Hospital Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
,
Marcel Arnold
4   Department of Neurology, University Hospital, Bern, Switzerland
,
Patrik Michel
1   Department of Neurology, Centre Hospital Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
› Author Affiliations
Further Information

Publication History

Received: 01 June 2014

Accepted after major revision: 21 January 2014

Publication Date:
24 November 2017 (online)

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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

* Current address: Department of Medical Imaging and Surgery, University of Toronto, Toronto, Ontario, Canada


 

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