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.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.