Author(s): Gonzlez RG, Lev MH, Goldmacher GV, Smith WS, Payabvash S,
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Abstract PURPOSE: To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA). METHODS: In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as "major" by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was ≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores >10. RESULTS: Of 649 patients, 253 (39.0\%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p<0.0001). Combining NIHSS with BASIS was highly predictive: 77.6\% (114/147) classified as NIHSS>10/BASIS+ had poor outcomes, versus 21.5\% (77/358) with NIHSS≤10/BASIS- (p<0.0001), regardless of treatment. The odds ratios for poor outcome is 12.6 (95\% CI: 7.9 to 20.0) in patients who are NIHSS>10/BASIS+ compared to patients who are NIHSS≤10/BASIS-; the odds ratio is 5.4 (95\% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+. CONCLUSIONS: BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment.
This article was published in PLoS One
and referenced in Journal of Addiction Research & Therapy