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Ischemic stroke
Original research
Predictors for large vessel recanalization before stroke thrombectomy: the HALT score
  1. Marco Colasurdo1,
  2. Huanwen Chen1,2,
  3. Chad Schrier3,
  4. Mazhar Khalid4,
  5. Mihir Khunte5,
  6. Timothy R Miller1,
  7. Jacob Cherian6,
  8. Ajay Malhotra7,
  9. Dheeraj Gandhi1,3,6
  1. 1 Division of Interventional Neuroradiology, Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
  2. 2 National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
  3. 3 Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
  4. 4 Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
  5. 5 Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  6. 6 Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
  7. 7 Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Dheeraj Gandhi, Division of Interventional Neuroradiology, Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA; dgandhi{at}umm.edu

Abstract

Background Large vessel recanalization (LVR) before endovascular therapy (EVT) for acute large vessel ischemic strokes is a poorly understood phenomenon. Better understanding of predictors for LVR is important for optimizing stroke triage and patient selection for bridging thrombolysis.

Methods In this retrospective cohort study, consecutive patients presenting to a comprehensive stroke center for EVT treatment were identified from 2018 to 2022. Demographic information, clinical characteristics, intravenous thrombolysis (IVT) use, and LVR before EVT were recorded. Factors independently associated with different rates of LVR were identified, and a prediction model for LVR was constructed.

Results 640 patients were identified. 57 (8.9%) patients had LVR before EVT. A minority (36.4%) of LVR patients had significant improvements in National Institutes of Health Stroke Scale. Independent predictors for LVR were identified and used to construct the 8-point HALT score: hyperlipidemia (1 point), atrial fibrillation (1 point), location of vascular occlusion (internal carotid: 0 points, M1: 1 point, M2: 2 points, vertebral/basilar: 3 points), and thrombolysis at least 1.5 hours before angiography (3 points). The HALT score had an area under the receiver-operating curve (AUC) of 0.85 (95% CI 0.81 to 0.90, P<0.001) for predicting LVR. LVR before EVT occurred in only 1 of 302 patients (0.3%) with low (0–2) HALT scores.

Conclusions IVT at least 1.5 hours before angiography, site of vascular occlusion, atrial fibrillation, and hyperlipidemia are independent predictors for LVR. The 8-point HALT score proposed in this study may be a valuable tool for predicting LVR before EVT.

  • Stroke
  • Thrombectomy
  • Thrombolysis

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020220

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @marcocolasurdo MDneurorads, @HAlvinChenNeuro, @Mihir_Khunte

    • MC and HC contributed equally.

    • Contributors Study conception and design: MC, HC, DG; data collection: HC, MK, DG; analysis and interpretation of results: MC, HC, CS, MK, AM, DG; draft manuscript preparation: MC, HC, CS, TRM, JC, AM, DG. All authors reviewed the results and approved the final version of the manuscript. DG is responsible for the overall content and is the guarantor of this study. MC and HC contributed equally to this work and are co-first authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer This article was prepared while HC was acting as a research fellow at the University of Maryland Medical Center. The opinions expressed in this article are the authors’ own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States Government.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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