Qureshi Grading Scheme for Angiographic Occlusions Strongly Correlates With the Initial Severity and In-Hospital Outcome of Acute Ischemic Stroke

Abstract

The thrombolysis in myocardial infarction (TIMI) grading scheme and other classification systems have limitations in evaluating patients with ischemic stroke because they do not account for occlusion location or collateral circulation. The Qureshi grading scheme has been recently proposed to evaluate the severity of arterial occlusion in acute ischemic stroke because of limitations in existing grading systems. The Qureshi grading scheme assigns a score from 0 to 5 on the basis of occlusion site and collateral supply. The authors determined the relationship between initial severity of stroke and outcome at discharge measured by the National Institutes of Health Stroke Scale (NIHSS) and the Qureshi grading scale assessed from initial angiography (by a neuroradiologist blinded to the clinical examination) in 57 patients who underwent intra-arterial therapy for acute ischemic stroke within 6 hours of symptom onset. A strong association was observed between the initial severity of neurological deficits and Qureshi scheme on angiography (F ratio = 2.6, P =.03). The initial NIHSS for grade 1 was 11 +/- 4 and progressively increased to 23 +/- 6 for grade 5. In the multivariate analysis, initial NIHSS was significantly associated with Qureshi scheme on angiography (R2 = 358, P =.03). The mean discharge NIHSS was 12 +/- 10 (range, 0-40). There was also a direct relationship between the Qureshi scheme and discharge NIHSS (F ratio = 2.8, P =.02). The Qureshi grading scheme can be effectively used to determine the severity of ischemic stroke (brain at risk) from the initial angiography.