Improved outcome prediction using CT angiography in addition to standard ischemic stroke assessment: results from the STOPStroke study
To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA). In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA...
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| Veröffentlicht in: | PloS one 2012-01, Vol.7 (1), p.e30352 |
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| creator | González, R Gilberto Lev, Michael H Goldmacher, Gregory V Smith, Wade S Payabvash, Seyedmehdi Harris, Gordon J Halpern, Elkan F Koroshetz, Walter J Camargo, Erica C S Dillon, William P Furie, Karen L |
| description | To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA).
In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as "major" by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was ≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores >10.
Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS- (p10/BASIS+ compared to patients who are NIHSS≤10/BASIS-; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+.
BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment. |
| doi_str_mv | 10.1371/journal.pone.0030352 |
| format | Article |
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In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as "major" by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was ≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores >10.
Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p<0.0001). Combining NIHSS with BASIS was highly predictive: 77.6% (114/147) classified as NIHSS>10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS- (p<0.0001), regardless of treatment. The odds ratios for poor outcome is 12.6 (95% CI: 7.9 to 20.0) in patients who are NIHSS>10/BASIS+ compared to patients who are NIHSS≤10/BASIS-; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+.
BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0030352</identifier><identifier>PMID: 22276182</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Angiography ; Arteries ; Brain Ischemia - diagnosis ; Brain Ischemia - diagnostic imaging ; Cerebral Angiography - methods ; Cerebral blood flow ; Classification ; Collaboration ; Computed tomography ; Female ; Hospitals ; Humans ; Ischemia ; Male ; Medical imaging ; Medical imaging equipment ; Medical schools ; Medicine ; Middle Aged ; Neurology ; Occlusion ; Patient outcomes ; Patients ; Predictions ; Stroke ; Stroke - diagnosis ; Stroke - diagnostic imaging ; Tomography ; Tomography, X-Ray Computed - methods</subject><ispartof>PloS one, 2012-01, Vol.7 (1), p.e30352</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>2012 González et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>González et al. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c691t-f66db570a2fb559e22e8250aa3804fe71caf026b8e270e803e646412a16dd1ff3</citedby><cites>FETCH-LOGICAL-c691t-f66db570a2fb559e22e8250aa3804fe71caf026b8e270e803e646412a16dd1ff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262833/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262833/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2101,2927,23865,27923,27924,53790,53792,79471,79472</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22276182$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Kiechl, Stefan</contributor><creatorcontrib>González, R Gilberto</creatorcontrib><creatorcontrib>Lev, Michael H</creatorcontrib><creatorcontrib>Goldmacher, Gregory V</creatorcontrib><creatorcontrib>Smith, Wade S</creatorcontrib><creatorcontrib>Payabvash, Seyedmehdi</creatorcontrib><creatorcontrib>Harris, Gordon J</creatorcontrib><creatorcontrib>Halpern, Elkan F</creatorcontrib><creatorcontrib>Koroshetz, Walter J</creatorcontrib><creatorcontrib>Camargo, Erica C S</creatorcontrib><creatorcontrib>Dillon, William P</creatorcontrib><creatorcontrib>Furie, Karen L</creatorcontrib><title>Improved outcome prediction using CT angiography in addition to standard ischemic stroke assessment: results from the STOPStroke study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA).
In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as "major" by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was ≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores >10.
Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p<0.0001). Combining NIHSS with BASIS was highly predictive: 77.6% (114/147) classified as NIHSS>10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS- (p<0.0001), regardless of treatment. The odds ratios for poor outcome is 12.6 (95% CI: 7.9 to 20.0) in patients who are NIHSS>10/BASIS+ compared to patients who are NIHSS≤10/BASIS-; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+.
BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography</subject><subject>Arteries</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - diagnostic imaging</subject><subject>Cerebral Angiography - methods</subject><subject>Cerebral blood flow</subject><subject>Classification</subject><subject>Collaboration</subject><subject>Computed tomography</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical imaging equipment</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Occlusion</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Predictions</subject><subject>Stroke</subject><subject>Stroke - 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In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as "major" by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was ≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores >10.
Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p<0.0001). Combining NIHSS with BASIS was highly predictive: 77.6% (114/147) classified as NIHSS>10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS- (p<0.0001), regardless of treatment. The odds ratios for poor outcome is 12.6 (95% CI: 7.9 to 20.0) in patients who are NIHSS>10/BASIS+ compared to patients who are NIHSS≤10/BASIS-; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+.
BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22276182</pmid><doi>10.1371/journal.pone.0030352</doi><tpages>e30352</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Aged, 80 and over Angiography Arteries Brain Ischemia - diagnosis Brain Ischemia - diagnostic imaging Cerebral Angiography - methods Cerebral blood flow Classification Collaboration Computed tomography Female Hospitals Humans Ischemia Male Medical imaging Medical imaging equipment Medical schools Medicine Middle Aged Neurology Occlusion Patient outcomes Patients Predictions Stroke Stroke - diagnosis Stroke - diagnostic imaging Tomography Tomography, X-Ray Computed - methods |
| title | Improved outcome prediction using CT angiography in addition to standard ischemic stroke assessment: results from the STOPStroke study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-08T16%3A02%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Improved%20outcome%20prediction%20using%20CT%20angiography%20in%20addition%20to%20standard%20ischemic%20stroke%20assessment:%20results%20from%20the%20STOPStroke%20study&rft.jtitle=PloS%20one&rft.au=Gonz%C3%A1lez,%20R%20Gilberto&rft.date=2012-01-20&rft.volume=7&rft.issue=1&rft.spage=e30352&rft.pages=e30352-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0030352&rft_dat=%3Cgale_plos_%3EA477056934%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1323091641&rft_id=info:pmid/22276182&rft_galeid=A477056934&rft_doaj_id=oai_doaj_org_article_56b0434e3ac042beb1fb29099f481243&rfr_iscdi=true |