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E-040 Analysis of the SPAN-100 Index as a Predictor of Clinical Outcome in the Post-Marketing North American SOLITAIRE Stent-Retriever Acute Stroke Registry
  1. A Castonguay1,
  2. O Zaidat1,
  3. R Novakovic2,
  4. R Gupta3,
  5. C Sun3,
  6. C Martin4,
  7. W Holloway5,
  8. N Mueller-Kronast6,
  9. J English7,
  10. I Linfante8,
  11. G Dabus8,
  12. T Malisch9,
  13. F Marden10,
  14. H Bozorgchami11,
  15. A Xavier12,
  16. A Rai13,
  17. M Froehler14,
  18. A Badruddin15,
  19. T Nguyen16,
  20. M Taqi17,
  21. M Abraham18,
  22. V Janardhan19,
  23. H Shaltoni20,
  24. A Yoo21,
  25. A Abou-Chebl22
  1. 1Stroke, Neurocritical Care, and Neurointerventional (SNN) Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
  2. 2UT Southwestern Medical Center, Dallas, TX, USA
  3. 3Emory University School of Medicine, Atlanta, GA, USA
  4. 4Saint Luke’s Kansas City, Kansas City, MO, USA
  5. 5Saint Luke’s Kansas City, Kansas City, KS, USA
  6. 6Delray Medical Center, Delray Beach, FL, USA
  7. 7California Pacific Medical Center, San Francisco, CA, USA
  8. 8Baptist Cardiac and Vascular Institute, Miami, FL, USA
  9. 9Alexian Brothers Medical Center, Elk Grove Village, IL, USA
  10. 10Alexian Brothers Medical Center, Elk Grove Village, WI, USA
  11. 11Oregon Health and Science University, Portland, OR, USA
  12. 12Wayne State University School of Medicine, Detroit, MI, USA
  13. 13West Virginia University Hospital, Morgantown, WV, USA
  14. 14Vanderbilt University Medical Center, Nashville, TN, USA
  15. 15Provena Saint Joseph Medical Center, Joliet, IL, USA
  16. 16Boston Medical Center, Boston, MA, USA
  17. 17Desert Regional Medical Center, Palm Springs, CA, USA
  18. 18University of Kansas Medical Center, Kansas City, KS, USA
  19. 19Texas Stroke Institute, Plano, TX, USA
  20. 20University of Texas Health Science Center, Houston, TX, USA
  21. 21Massachusetts General Hospital, Boston, MA, USA
  22. 22University of Louisville Medical School, Louisville, KY, USA

Abstract

Background In light of the negative results of three randomised trials for endovascular acute ischemic stroke therapy, proper patient selection has become a critical area of focus for endovascular therapy. The Stroke Prognostication using Age and NIH Stroke Scale (SPAN) index, a score that combines age and NIHSS, demonstrated that SPAN-100 positive patients did not benefit from IV-tPA. Here, we sought to evaluate the predictive value of SPAN index in a real-life cohort of patients undergoing endovascular therapy.

Method Using data from the investigator-initiated, multicenter North American Solitaire Stent-Retriever Acute Stroke (NASA) Registry, the SPAN index was calculated for each patient (age plus NIHSS). A cohort of SPAN-100 positive (SPAN ≥ 100) patients was identified and compared to SPAN-100 negative (SPAN <100) patients. Successful recanalization was defined as Thrombolysis in Myocardial Infarction (TIMI) ≥2. Good clinical outcome was defined as a 90-day mRS ≤ 2.

Results Of 354 patients in the NASA Registry, 308 had available baseline NIHSS scores and 90-day mRS scores. 68/354 (22.1%) patients were SPAN-100 positive. Mean age of patients that were SPAN-100 positive was 83.9 ± 5.6 years vs. 62.8 ± 13.3 years in the SPAN-100 negative cohort (p = < 0.0001). No difference was seen in the rate of successful reperfusion (TIMI ≥ 2) among the groups (p = 0.9). Only 26.5% (18/68) of patients in the SPAN-100 positive cohort had a 90-day mRS ≤ 2 vs. 47.1% (113/240) of those SPAN-100 negative (p = 0.002). Mortality was 50.0% (34/68) and 24.6% (59/240) in SPAN-100 positive and SPAN-100 negative, respectively. In a multivariate analysis, SPAN-100 positive was shown as an independent predictor of clinical outcome, with 2.5 times greater likelihood of worse outcome versus those with SPAN-100 negative (OR 2.5; 95% CI 1.3–5.1; p = 0.006).

Conclusion Analysis of the NASA Registry demonstrated that SPAN-100 positive is significantly associated with worse clinical outcome and higher mortality rate at 90 days compared to SPAN-100 negative patients. SPAN-100 was shown as an independent predictor of clinical outcome and may be useful tool in the selection of patients for endovascular therapy.

Disclosures A. Castonguay: None. O. Zaidat: 1; C; Stryker Neurovascular, Covidien Neurovascular. 2; C; Covidien Neurovascular. R. Novakovic: None. R. Gupta: None. C. Sun: None. C. Martin: None. W. Holloway: None. N. Mueller-Kronast: None. J. English: None. I. Linfante: None. G. Dabus: None. T. Malisch: None. F. Marden: None. H. Bozorgchami: None. A. Xavier: None. A. Rai: None. M. Froehler: None. A. Badruddin: None. T. Nguyen: None. M. Taqi: None. M. Abraham: None. V. Janardhan: None. H. Shaltoni: None. A. Yoo: None. A. Abou-Chebl: None.

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