Risk Stratification for Endovascular Treatment in Acute Anterior Circulation Occlusive Stroke

Abstract

Objective: To develop and validate a novel scoring system for risk stratification in acute anterior circulation large vessel occlusion stroke patients undergoing endovascular treatment.

Methods: Subjects were included from a multicenter registry on acute ischemic stroke undergoing thrombectomy in China. Two thirds of the patients were used as the derivation group and the other one third of the patients as the validation group. Multivariable logistic regression was used to generate the scoring system. The area under the receiver operating characteristic curve and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration, respectively.

Results: The Risk strAtification for eNdovascular treatment in acute anterior circulation occlusive stroKe (RANK) scale (total score ranges from -11 to 14) showed good discrimination in the derivation cohort (AUC = .79; 95% confidence interval [CI], .74-.84) and validation cohorts (AUC = .74; 95% CI, .68-.81), as well as good calibration (Hosmer-Lemeshow test) in the validation cohort (P = .54). We categorized the RANK score into 5 predictive groups for an unfavorable functional outcome, less than or equal to -8 (very low risk), -7 to -4 (low risk), -3 to 0 (intermediate), 1-5 (high risk), and greater than or equal to 6 (very high risk). In the very high risk group, only 3.3% (1 of 30, 95% CI: .08%-.2%) of patients in the derivation group and 5.5% (1 of 18, 95% CI: .1%-.3%) of patients in the validation group achieved a good functional outcome at day 90.

Conclusions: The novel scale is a valid tool for risk stratification for endovascular stroke treatment in anterior circulation large vessel occlusions.

Keywords: Stroke; endovascular treatment; scale; thrombolysis.