ASTRAL-R score predicts non-recanalisation after intravenous thrombolysis in acute XXXX .

@entity1 @entity64 @entity853 @entity432
UNASSIGNED: Intravenous thrombolysis (IVT) as treatment in acute @entity64 may be insufficient to achieve recanalisation in certain @entity1 . Predicting probability of non-recanalisation after IVT may have the potential to influence @entity1 selection to more aggressive management strategies. We aimed at deriving and internally validating a predictive score for post-thrombolytic non-recanalisation, using clinical and radiological variables. In thrombolysis registries from four Swiss academic @entity64 centres (Lausanne, Bern, Basel and Geneva), @entity1 were selected with large @entity432 on acute imaging and with repeated arterial assessment at 24 hours. Based on a logistic regression analysis, an integer-based score for each covariate of the fitted multivariate model was generated. Performance of integer-based predictive model was assessed by bootstrapping available data and cross validation (delete-d method). In 599 @entity64 , five variables were identified as independent predictors of absence of recanalisation: Acute glucose >   7 mmol/l (A), significant @entity853 (ST), decreased Range of visual fields (R), large @entity432 (A) and decreased Level of consciousness (L). All variables were weighted 1, except for (L) which obtained 2 points based on b-coefficients on the logistic scale. ASTRAL-R scores 0, 3 and 6 corresponded to non-recanalisation probabilities of 18, 44 and 74   % respectively. Predictive ability showed AUC of 0.66 (95   %CI, 0.61-0.70) when using bootstrap and 0.66 (0.63-0.68) when using delete-d cross validation. In conclusion, the 5-item ASTRAL-R score moderately predicts non-recanalisation at 24 hours in thrombolysed @entity64 . If its performance can be confirmed by external validation and its clinical usefulness can be proven, the score may influence @entity1 selection for more aggressive revascularisation strategies in routine clinical practice.
