Abstract T P192: Interventional Stroke Assessment Scale for Eligibility in Endovascular Therapy (ISAS-ET)

Abstract

Background and Purpose: During the last two decades, we have witnessed advancements in the field of endovascular treatment of stroke, especially after showing the benefit of Intravenous tissue plasminogen activator (IV tPA). Despite these innovations in the field, only 55% or less of patients were shown to have good outcomes in multiple randomized clinical trials. Methods: This is a retrospective analysis of all patients (n= 97) who presented to our hospital with ischemic stroke and received mechanical thrombectomy with or without IV tPA between January 2009 and July 2012 and had all possible variables documented in their charts. Statistical analysis was performed using the R statistical package and XLSTAT-Pro 2011. Spearman correlations (P value <0.05) for non-normally distributed data were used to independently evaluate the correlation of all the variables including age, gender, site of occlusion, time to intervention, baseline NIHSS, volume of infarct core at presentation, hypertension, diabetes, hyperlipidemia, atrial fibrillation (AFib), coronary artery disease, prior strokes and disability and smoking with the patient functional outcome at discharge using a modified rankin scale (mRS). mRS of 2 or less represented a good functional outcome. Results: 80 patients had all previously mentioned variables. Group analysis including gender, mean age, mean NIHSS, percentage of AFib and mortality at discharge was as follows: Female 50%, 72.9, 14.5, 31.0% and 13%. There was a significant negative correlation with the outcome if a patient had a NIHSS more than 20, age above 65, presence of AFib, prior strokes or disability, volume of infarct core on perfusion studies or reformat CT angiography more than 75 cm3 (P value <0.05). The scoring system was developed with a score range (0-8), where a high score predicts a better outcome. Infarct core volume 75 cm3 received 2, 1, 0 points respectively; NIHSS20 received 2, 1, 0 points respectively; Age <65 received 1 point; absence of AFib received 1 point, time of onset <3 hours received 1 point, no prior stroke or disability received 1 point. Conclusion: The ISAS scoring system might help with assessment of patient qualification for endovascular treatment. Further prospective studies validating the score are warranted.