MT-DRAGON score for outcome prediction in acute ischemic stroke treated by mechanical thrombectomy within 8 hours

Abstract

ObjectivesThe MRI-DRAGON score includes clinical and MRI parameters and demonstrates a high specificity in predicting 3 month outcome in patients with acute ischemic stroke (AIS) treated with intravenous tissue plasminogen activator (IV tPA). The aim of this study was to adapt this score to mechanical thrombectomy (MT) in a large multicenter cohort.MethodsConsecutive cases of AIS treated by MT between January 2015 and December 2017 from three stroke centers were reviewed (n=1077). We derived the MT-DRAGON score by keeping all variables of the MRI-DRAGON score (age, initial National Institutes of Health Stroke Scale score, glucose level, pre-stroke modified Rankin Scale (mRS) score, diffusion weighted imaging-Alberta Stroke Program Early CT score ≤5) and considering the following variables: time to groin puncture instead of onset to IV tPA time and occlusion site. Unfavorable 3 month outcome was defined as a mRS score >2. Score performance was evaluated by c statistics and an external validation was performed.ResultsAmong 679 included patients (derivation and validation cohorts, n=431 and 248, respectively), an unfavorable outcome was similar between the derivation (51.5%) and validation (58.1%, P=0.7) cohorts, and was significantly associated with all MT-DRAGON parameters in the multivariable analysis. The c statistics for unfavorable outcome prediction was 0.83 (95%CI 0.79 to 0.88) in the derivation and 0.8 (95%CI 0.75 to 0.86) in the validation cohort. All patients (n=55) with an MT-DRAGONscore ≥11 had an unfavorable outcome and 60/63 (95%) patients with an MT-DRAGON score ≤2 points had a favorable outcome.ConclusionThe MT-DRAGON score is a simple tool, combining admission clinical and radiological parameters that can reliably predict 3 month outcome after MT.

Predictive factors of functional independence after optimal reperfusion in anterior circulation ischaemic stroke with indication for intravenous thrombolysis plus mechanical thrombectomy

“…However, the association between CBS and 3‐month outcome is mediated by its influence on the reperfusion therapy success, which explains why CBS was no longer an essential factor in our recanalized population [28]. Moreover, the occlusion site appears as a predictive factor in the MT‐DRAGON model because it probably identifies a major subset of severity: tandem occlusion whose treatment is not well codified to date [14].…”

“…A set of observational studies has shown that hypertension, glycemia, fever, ischaemic volume, leptomeningeal collaterals, thrombus characteristics and location are associated with clinically significant optimal reperfusion, regardless of their predictive value and without combining clinical-imaging criteria [12,13]. There is only one recent prediction model, derived from the DRAGON score,in this specific population treated by IVT+MT and who achieves optimal reperfusion [14][15][16][17]. However, it does not explore any predictive factors other than those already composing the primary DRAGON score, thus limiting the understanding of the mechanisms supporting clinically significant optimal reperfusion.…”

Mortality after large artery occlusion acute ischemic stroke

“…Among the common mortality associations in other studies include age 7 – 10 , 14 , 16 , initial stroke severity 7 – 9 , 13 – 16 presenting glucose 8 , 16 , pre-morbid function 7 – 9 , and history of atrial fibrillation 8 – 10 , 15 . We similarly found that age, initial stroke severity, presenting glucose, and history of atrial fibrillation were significant univariate associations with mortality risk, though among these factors, the multivariable model demonstrated independent mortality associations with increasing age, presenting NIHSS, and discharge mRS.…”

Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume

“…Mechanical thrombectomy (MT) in acute ischemic stroke substantially improves functional outcome in patients with large vessel occlusion [ 18 , 34 ]. Yet, the time-sensitive selection of patients who will most likely benefit from MT is a critical factor in clinical practice.…”