Background

While endovascular thrombectomy (EVT) is beneficial for patients with acute large vessel occlusion ischemic strokes, a significant portion of patients still do poorly despite successful recanalization. Identifying patients at high risk for poor outcomes can be helpful for future clinical trial design and optimizing acute stroke triage.

Methods

Consecutive EVT patients were identified from 2016 to 2021 at a Comprehensive Stroke Center, and clinical information was recorded. Poor outcome was defined as a 90-day modified Rankin Scale (mRS) of 4 or greater despite achieving a modified thrombolysis in cerebral infarction (mTICI) score of 2b or greater. Multivariable regression analyses were used to identify risk factors for poor outcomes, and a scoring system was constructed.

Results

483 patients with successful recanalization were identified. From a randomly selected training cohort (n=357), the 10-point BAND score was constructed from independent risk factors for poor outcomes: baseline disability (1 point: baseline mRS ≥ 2), age (1 point: 60-69 years, 2 points: 70-79 years, 3 points: 80-84 years, 4 points: 85 years or older), NIHSS (2 points: 13-17, 3 points: 18-22, and 4 points: ≥ 23), and delay from last known normal (1 point: ≥ 6 hours). The BAND score was significantly associated with rates of poor outcomes (p<0.001), and it achieved an area under the receiver-operating characteristic curve (AUC) of 0.80 (95%CI 0.76-0.85) in our training cohort and 0.78 (95%CI 0.70-0.86) in our validation cohort (n=126). Overall, the BAND score had a significantly higher AUC value than the widely validated THRIVE score and the THRIVE-EVT calculation (p=0.001 and 0.029, respectively). Among patients with high BAND scores (7 or higher), 88.2% had poor outcomes.

Conclusion

The BAND score is a simple tool to predict poor outcomes despite successful recanalization. Future studies are needed to confirm the BAND score's external validity.

中文翻译：

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BAND 评分：尽管中风血栓切除术成功，但仍可预先预测不良结果的简单模型

背景

虽然血管内血栓切除术（EVT）对急性大血管闭塞缺血性中风患者有益，但尽管血管再通成功，仍有相当一部分患者的情况不佳。识别预后不良的高风险患者有助于未来的临床试验设计和优化急性卒中分诊。

方法

综合卒中中心从 2016 年至 2021 年连续识别了 EVT 患者，并记录了临床信息。尽管脑梗死改良溶栓 (mTICI) 评分达到 2b 或更高，但 90 天改良 Rankin 量表 (mRS) 为 4 或更高，结果仍为不良。使用多变量回归分析来确定不良结果的风险因素，并构建了评分系统。

结果

确定了 483 名成功再通的患者。从随机选择的训练队列 (n=357) 中，10 分 BAND 评分是根据不良结果的独立危险因素构建的：基线残疾（1 分：基线 mRS ≥ 2）、年龄（1 分：60-69 岁、 2分：70-79岁，3分：80-84岁，4分：85岁或以上），NIHSS（2分：13-17，3分：18-22，4分：≥23），以及与上次已知正常值相比有延迟（1 点：≥ 6 小时）。BAND 评分与不良结局发生率显着相关 (p<0.001)，并且在我们的训练队列中，其接受者操作特征曲线 (AUC) 下的面积为 0.80 (95%CI 0.76-0.85)，在我们的训练队列中达到了 0.78 (95%CI)。在我们的验证队列 (n=126) 中，%CI 0.70-0.86）。总体而言，BAND 评分的 AUC 值显着高于广泛验证的 THRIVE 评分和 THRIVE-EVT 计算（分别为 p=0.001 和 0.029）。在 BAND 评分较高（7 或更高）的患者中，88.2% 的患者预后较差。

结论

BAND 评分是一个简单的工具，可以预测再通成功后的不良结果。未来的研究需要确认 BAND 评分的外部有效性。