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Development and validation of a SCORing systEm for pre-thrombectomy diagnosis of IntraCranial Atherosclerotic Disease (Score-ICAD).
A Tarek, Mohamed; Damiani Monteiro, Mateus; Mohammaden, Mahmoud H; Martins, Pedro N; Sheth, Sunil A; Dolia, Jaydevsinh; Pabaney, Aqueel; Grossberg, Jonathan A; Nahhas, Michael; A De La Garza, Carlos; Salazar-Marioni, Sergio; Rangaraju, Srikant; Nogueira, Raul G; Haussen, Diogo C.
Afiliación
  • A Tarek M; Neurology Department, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Damiani Monteiro M; Department of Neurology and Psychological Medicine, Sohag University Faculty of Medicine, Sohag, Egypt.
  • Mohammaden MH; Emory University School of Medicine, Atlanta, Georgia, USA.
  • Martins PN; Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA.
  • Sheth SA; Department of Neurology, Emory University Atlanta, Atlanta, Georgia, USA.
  • Dolia J; Neurology Department, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Pabaney A; Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA.
  • Grossberg JA; Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA.
  • Nahhas M; Neurology Department, Emory University School of Medicine, Atlanta, Georgia, USA.
  • A De La Garza C; Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Salazar-Marioni S; Emory University, Atlanta, Georgia, USA.
  • Rangaraju S; Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Nogueira RG; Department of Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA.
  • Haussen DC; Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA.
J Neurointerv Surg ; 2024 May 23.
Article en En | MEDLINE | ID: mdl-38782568
ABSTRACT

BACKGROUND:

Early identification of intracranial atherosclerotic disease (ICAD) may impact the management of patients undergoing mechanical thrombectomy (MT). We sought to develop and validate a scoring system for pre-thrombectomy diagnosis of ICAD in anterior circulation large vessel/distal medium vessel occlusion strokes (LVOs/DMVOs).

METHODS:

Retrospective analysis of two prospectively maintained comprehensive stroke center databases including patients with anterior circulation occlusions spanning 2010-22 (development cohort) and 2018-22 (validation cohort). ICAD cases were matched for age and sex (11) to non-ICAD controls.

RESULTS:

Of 2870 MTs within the study period, 348 patients were included in the development cohort 174 anterior circulation ICAD (6% of 2870 MTs) and 174 controls. Multivariable analysis ß coefficients led to a 20 point scale absence of atrial fibrillation (5); vascular risk factor burden (1) for each of hypertension, diabetes, smoking, and hyperlipidemia; multifocal single artery stenoses on CT angiography (3); absence of territorial cortical infarct (3); presence of borderzone infarct (3); or ipsilateral carotid siphon calcification (2). The validation cohort comprised 56 ICAD patients (4.1% of 1359 MTs) 56 controls. Area under the receiver operating characteristic curve was 0.88 (0.84-0.91) and 0.82 (0.73-0.89) in the development and validation cohorts, respectively. Calibration slope and intercept showed a good fit for the development cohort although with overestimated risk for the validation cohort. After intercept adjustment, the overestimation was corrected (intercept 0, 95% CI -0.5 to -0.5; slope 0.8, 95% CI 0.5 to 1.1). In the full cohort (n=414), ≥11 points showed the best performance for distinguishing ICAD from non-ICAD, with 0.71 (95% CI 0.65 to 0.78) sensitivity and 0.82 (95% CI 0.77 to 0.87) specificity, and 3.92 (95% CI 2.92 to 5.28) positive and 0.35 (95% CI 0.28 to 0.44) negative likelihood ratio. Scores ≥12 showed 90% specificity and 63% sensitivity.

CONCLUSION:

The proposed scoring system for preprocedural diagnosis of ICAD LVOs and DMVOs presented satisfactory discrimination and calibration based on clinical and non-invasive radiological data.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Neurointerv Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Neurointerv Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido