Abstract
Objectives: The combination of systemic thrombolysis and mechanical thrombectomy is indicated in patients with ischemic stroke due to a large vessel occlusion (LVO) and these treatments are time-dependent. Rapid identification of patients with suspected LVO also in a prehospital setting could influence the choice of the destination hospital. Aim of this pilot study was to evaluate the predictive role of a new stroke scale for LVO, comparing it to other scores.Patients and Methods: All consecutive patients admitted to our comprehensive stroke center with suspected ischemic stroke were studied with a CT angiography and 5 different stroke scales were applied. The Large ARtery Occlusion (LARIO) stroke scale consists of 5 items including the assessment of facial palsy, language alteration, grip and arm weakness, and the presence of neglect. A Receiving Operating Characteristic curve was evaluated for each stroke scale to explore the level of accuracy in LVO prediction.Results: A total of 145 patients were included in the analysis. LVO was detected in 37.2% of patients. The Area Under Curve of the LARIO score was 0.951 (95%CI: 0.902–0.980), similar to NIHSS and higher than other scales. The cut-off score for best performance of the LARIO stroke scale was higher than 3 (positive predictive value: 77% and negative predictive value: 100%).Conclusion: The LARIO stroke scale is a simple tool, showing high accuracy in detecting LVO, even if with some limitations due to some false positive cases. Its efficacy has to be confirmed in a pre-hospital setting and other centers.
Highlights
The combination of systemic thrombolysis and mechanical thrombectomy is indicated in patients with ischemic stroke due to a large vessel occlusion (LVO), and this recommendation has been validated by previous randomized controlled trials [1,2,3,4]
A recent meta-analysis of these studies showed a great heterogeneity of results with the best prediction observed for some scales [5], even if all presented a lower accuracy than the National Institute of Health Stroke scale (NIHSS) [6], and for this reason they presented several limitations in their application in a real-world setting
At this cut-off score, the Large ARterial Intracranial Occlusion (LARIO) Stroke scale showed a significantly higher discrimination of patients with LVO when compared with the other scales, NIHSS excluded
Summary
The combination of systemic thrombolysis and mechanical thrombectomy is indicated in patients with ischemic stroke due to a large vessel occlusion (LVO), and this recommendation has been validated by previous randomized controlled trials [1,2,3,4]. Large Vessel Occlusion Stroke Scale of symptoms in the pre-hospital setting and concomitant fast transportation to comprehensive centers, which have limited beds and resources For this reason, the concomitant time sensitivity for both treatments could influence the choice of the destination hospital. A recent meta-analysis of these studies showed a great heterogeneity of results with the best prediction observed for some scales [5], even if all presented a lower accuracy than the National Institute of Health Stroke scale (NIHSS) [6], and for this reason they presented several limitations in their application in a real-world setting According to these evidences, the vessel images are mandatory to select patients for mechanical thrombectomy as they detect LVO with higher accuracy
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