Improved Outcome Prediction Using CT Angiography in Addition to Standard Ischemic Stroke Assessment: Results from the STOPStroke Study

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Improved Outcome Prediction Using CT Angiography in Addition to Standard Ischemic Stroke Assessment: Results from the STOPStroke Study

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dc.contributor.author Lev, Michael Howard
dc.contributor.author Smith, Wade S.
dc.contributor.author Payabvash, Seyedmehdi
dc.contributor.author Harris, Gordon J.
dc.contributor.author Halpern, Elkan F.
dc.contributor.author Koroshetz, Walter J.
dc.contributor.author Dillon, William P.
dc.contributor.author Furie, Karen L.
dc.contributor.author Goldmacher, Gregory V.
dc.contributor.author Camargo, Erica Christina S.
dc.contributor.author González, Ramon Gilberto
dc.date.accessioned 2012-10-09T20:42:22Z
dc.date.issued 2012
dc.identifier.citation González, Ramon Gilberto, Michael Howard Lev, Gregory V. Goldmacher, Wade S. Smith, Seyedmehdi Payabvash, Gordon J. Harris, Elkan F. Halpern, et al. 2012. Improved outcome prediction using CT angiography in addition to standard ischemic stroke assessment: Results from the STOPStroke study. PLoS ONE 7(1): e30352. en_US
dc.identifier.issn 1932-6203 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:9709719
dc.description.abstract Purpose: To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA). Methods: 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\(\leq7\); (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. Results: 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\(\leq10\)/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\(\leq10\)/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+. Conclusions: 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. en_US
dc.language.iso en_US en_US
dc.publisher Public Library of Science en_US
dc.relation.isversionof doi:10.1371/journal.pone.0030352 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262833/pdf/ en_US
dash.license LAA
dc.title Improved Outcome Prediction Using CT Angiography in Addition to Standard Ischemic Stroke Assessment: Results from the STOPStroke Study en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal PLoS ONE en_US
dash.depositing.author González, Ramon Gilberto
dc.date.available 2012-10-09T20:42:22Z

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