A Combined Arterial and Venous Grading Scale to Predict Outcome in Anterior Circulation Ischemic Stroke. Issue 6 (17th June 2015) - Parthasarathy, Rajsrinivas
ABSTRACT OBJECTIVE Prognostic evaluation based on cortical vein score difference in stroke (PRECISE) score, a novel venous grading scale better predicted stroke outcomes. Henceforth, we aimed to describe and determine if a physiologically relevant combined arterial and venous grading scale (CRISP grading scale) is accurate in determining 90‐day stroke outcomes in patients with proximal arterial occlusion in the anterior circulation. METHODS Data are from the Keimyung Stroke Registry. Consecutive patients with M1 middle cerebral artery (MCA) or terminal internal carotid artery (ICA) occlusion on CT‐angiography (CTA) from May‐2004 to July‐2008 were included. The affected hemisphere 'four veins composite score' and 'arterial collaterals' were each graded 'good' and 'poor'. On the combined scale, a 'good' grade represented a 'good' score on both scales and a 'poor' grade represented a 'poor' score on both scales. The 'other two' combinations were graded 'intermediate.' RESULTS Eighty‐one patients were included in the study. Dummy variable regression analysis demonstrated that poor outcome was commonly seen in the group with poor arterial and venous grades [OR(95%CI); 48 (8.24, 279.598); P < 0.00001] as opposed to poor arterial collaterals alone [OR(95%CI); 9.6(1.483, 62.162); P = 0.018]. In multivariate analysis the CRISP grade [OR(95%CI); 2.638(1.192, 6.039), P = 0.017] and National Institutes of Health Stroke Scale [OR(95%CI);1.230(1.085, 1.395), P = 0.001(per unit increase)] emerged as the independent predictors of poor outcome (modified Rankin Scale >2) when adjusted for other imaging predictors of outcome. CONCLUSION CRISP grading was precise in predicting stroke outcomes when compared to individual imaging scales including arterial collateral grading, PRECISE score and CTA‐SI ASPECTS in patients with proximal arterial occlusion in the anterior circulation.