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Derivation and validation of a predictive scale to expedite endovascular intervention for acute stroke patients with an intervenable vessel occlusion
  1. Zeguang Ren1,
  2. Runqi Wangqin2,
  3. Francis Demiraj3,
  4. Weizhe Li4,
  5. Maxim Mokin5,
  6. Anxin Wang6,
  7. Zhongrong Miao7,
  8. Yongjun Wang8,
  9. W Scott Burgin9
  1. 1Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
  2. 2Duke Clinical Research Institute, Duke Univeristy Medical Center, Durham, North Carolina, USA
  3. 3Department of Neurology, FAU Schmidt College of Medicine, Boca Raton, Florida, USA
  4. 4Department of Neurology, Duke University, Durham, North Carolina, USA
  5. 5Department of Neurosurgery and Neurology, University of South Florida, Tampa, Florida, USA
  6. 6China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
  7. 7Department of Neurological Intervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  8. 8China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
  9. 9Department of Neurology, University of South Florida, Tampa, Florida, USA
  1. Correspondence to Dr W Scott Burgin, Department of Neurology, University of South Florida, Tampa, FL 33606, USA; wburgin{at}; Dr Zeguang Ren, Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China; renzem{at}


Background Early endovascular intervention team mobilization may reduce reperfusion times and improve clinical outcomes for patients with acute ischemic stroke (AIS) with a possible intervenable vessel occlusion (IVO). In an emergency department or mobile stroke unit, incorporating rapidly available non-contrast CT (NCCT) information with examination findings may improve the accuracy of arterial occlusion prediction scales. For this purpose, we developed a rapid and straightforward IVO predictive instrument—the T3AM2PA1 scale.

Methods The T3AM2PA1 scale was retrospectively derived from our ‘Get with the Guidelines’ database. We included all patients with acute stroke alert between January 2017 and August 2018 with a National Institutes of Health Stroke Scale (NIHSS) score between 5 and 25 inclusive. Different pre-intervention variables were collected, including itemized NIHSS and NCCT information. The T3AM2PA1 scale was also compared with other commonly used scales and was validated in a separate sequential retrospective cohort of patients with a full range of NIHSS scores.

Results 574 eligible patients from 2115 acute stroke alerts were identified. The scale was established with five items (CT hyperdense sign, parenchymal hypodensity, lateralizing hemiparesis, gaze deviation, and language disturbance), with a total score of 9. To minimize unnecessary angiography, a cut-off of ≥5 for IVO detection yielded a sensitivity of 52%, a specificity of 90%, and a positive predictive value of 76%.

Conclusions The T3AM2PA1 scale accurately predicts the presence of clinical IVO in patients with AIS. Adopting the T3AM2PA1 scale could reduce revascularization times, improve treatment outcomes, and potentially reduce disability.

  • thrombectomy
  • stroke

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors ZR, MM and WSB conceptualized the project by analyzing retrospective data to create the T3AM2PA1 scale. They oversaw the project and subsequent draft creation. WL, ZR, and WSB participated in data collection. RW and FD assisted in article drafting, graphical analysis, and journal submission. AW assisted in the statistical analysis and the scale establishment. ZM and YW contributed to the interpretation of the results, reviewed, and advised the drafting. ZR served as the guarantor for the project.

  • 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.

  • Competing interests WSB has received grants from Athersys, BMS, Florida High Tech Corridor, NIH, Reneuron, and VuEssence. His consulting activities include Genentech, VuEssence, with stock options in VuEssence. He has patents planned or pending with USF. His equity positions include holdings in Inur Technologies and Electron Transport Biotech. He also has a financial interest in PRIME Education. MM has received grants from the NIH and has consulted with Balt, Cerenovus, Medtronic, and Rapid Pulse. His testimony work includes Foley Mansfield and Huff Powell Bailey as clients. He has participated as an advisor for Cerenovus and Rapid Pulse. His financial holdings include Bendit Technologies, Borvo Medical, BrainQ, Endostream, Serenity Medical, Synchron, Sim & Cure, QAS AI, Quantanosis AI. ZR has received royalties for his publication on aneurysms and has lectured for Beijing Tiantan Hospital, the Chinese Stroke Association, and the Chinese Institute for Brain Research.

  • 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.