Predicting Clinical Outcome After Mechanical Thrombectomy: The GADIS score.

Abstract

OBJECTIVE\nInvestigate predictive factors and develop outcome assessment tool to determine clinical outcome after endovascular mechanical thrombectomy (EMT) in patient presenting with large vessel occlusion (LVO).\n\n\nMETHODS\nA retrospective analysis of a prospective cohort of patients who underwent EMT after adoption of expanded time window up to 24 hours in patients presenting with LVO. Final cerebral infarction volume (CIV) after EMT is estimated using magnetic resonance imaging (MRI) segmentation software. Stepwise linear regression models used to identify factors that determined clinical outcome and to develop predictive scale.\n\n\nRESULTS\nNinety patients underwent EMT over 19 months with 68 within 6 hours and 22 between 6-24 hours. Clinical outcome determined using modified Rankin score (mRS) at discharge and 3-months were no different among these sub-cohorts. A threshold of 16.99 ml of CIV, using Youden s index, resulted in a sensitivity of 90.5% and specificity of 58.1% for predicting mRS 0-2. Regression model identified gender, age, diabetes mellitus status, CIV and smoking status as outcome determinants and are used to develop GADIS scoring system to predict good clinical outcome. Using GADIS score, a score of <6 predicted mRS 0-2 at discharge with a sensitivity of 83.3% and specificity of 80.6%.\n\n\nCONCLUSION\nGADIS score for LVO related AIS patients, includes CIV post-EMT and would help in early short-term prognostication. It is not intended to predict pre-intervention patient selection or outcome prediction.