Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry)
Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry)
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DOI：
10.1161/strokeaha.116.014431
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发表时间：
2017-02-01
期刊：
影响因子：
8.3
通讯作者：
Lees, Kennedy R.
中科院分区：
文献类型：
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作者：
Scheitz, Jan F.;Abdul-Rahim, Azmil H.;Lees, Kennedy R.
背景和目的美国国立卫生研究院卒中量表（NIHSS）与大前血管闭塞（LAVO）的存在相关。然而，在院前环境中，完整NIHSS在选择适合血栓切除术治疗的患者方面的应用有限。因此，我们旨在评估简单的临床选择策略的预后价值。方法回顾性分析2012年1月至2014年5月国际卒中溶栓登记处安全实施溶栓治疗的数据。纳入了NIHSS评分完全分解和记录血管状态的患者。我们评估了院前卒中量表和NIHSS症状与LAVO（颈内动脉、颈动脉末端或大脑中动脉M1段）的相关性。NIHSS项目最佳凝视的病理结果与LAVO密切相关（调整后的比值比4.5，95%置信区间3.8-5.3）。所有3个面臂言语时间测试（FAST）项目均以高灵敏度识别LAVO。在原始FAST评分（G-FAST）或其他简化卒中量表的高分中添加项目凝视可增加特异性。代表总前路综合征的NIHSS症状特征显示，LAVO的可能性是非特异性临床特征的10倍。如果与NIHSS阈值为6相比，院前卒中量表表现相似，甚至更好，而不会失去sensitivity.Conclusions简单修改的脸臂语音时间评分或评估NIHSS症状的个人资料可能有助于分层患者的风险LAVO和识别个人谁值得迅速转移到综合中风centers. Conclusions。需要在院前环境中进行前瞻性验证。
Background and Purpose The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies.Methods Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012-May 2014) were analyzed retrospectively. Patients with complete breakdown of NIHSS scores and documented vessel status were included. We assessed the association of prehospital stroke scales and NIHSS symptom profiles with LAVO (internal carotid artery, carotid-terminus or M1-segment of the middle cerebral artery).Results Among 3505 patients, 23.6% (n=827) had LAVO. Pathological finding on the NIHSS item best gaze was strongly associated with LAVO (adjusted odds ratio 4.5, 95% confidence interval 3.8-5.3). All 3 face-arm-speech-time test (FAST) items identified LAVO with high sensitivity. Addition of the item gaze to the original FAST score (G-FAST) or high scores on other simplified stroke scales increased specificity. The NIHSS symptom profiles representing total anterior syndromes showed a 10-fold increased likelihood for LAVO compared with a nonspecific clinical profile. If compared with an NIHSS threshold of 6, the prehospital stroke scales performed similarly or even better without losing sensitivity.Conclusions Simple modification of the face-arm-speech-time score or evaluating the NIHSS symptom profile may help to stratify patients' risk of LAVO and to identify individuals who deserve rapid transfer to comprehensive stroke centers. Prospective validation in the prehospital setting is required.