eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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SCImago Journal & Country Rank
 
3/2022
vol. 18
 
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abstract:
Original paper

Association of CHA2DS2-VASc score with successful recanalization in acute ischemic stroke patients undergoing endovascular thrombectomy

Muharrem Nasifov
1
,
Emre Ozmen
2
,
Cigdem Deniz
3
,
Aydin Nadir
4
,
Ozge Ozden
1
,
Gulsum Bingol
1
,
Perviz Jafarov
5
,
Talip Asil
3
,
Omer Goktekin
1
,
Ibrahim Sari
1

1.
Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
2.
Siirt Eğitim ve Araştırma Hastanesi, Cardiology Clinic, Istanbul, Turkey
3.
Neurology Clinic, Memorial Hizmet Hospital, Istanbul, Turkey
4.
Cardiology Department, School of Medicine, Bezmialem University, Istanbul, Turkey
5.
Cardiology Clinic, Memorial Hizmet Hospital, Istanbul, Turkey
Adv Interv Cardiol 2022; 18, 3 (69): 269–275
Online publish date: 2022/12/17
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Introduction
The CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease and sex) score is a simple risk stratification algorithm to estimate stroke/thromboembolic risk in patients with non-valvular atrial fibrillation (AF). Higher pre-stroke CHA2DS2-VASc score is known to be associated with greater stroke severity and poorer outcomes. AF patients generally have higher CHA2DS2-VASc scores than non-AF patients. The Modified Thrombolysis in Cerebral Infarction (mTICI) score is the most widely used grading system to assess the result of recanalizing therapies in acute ischemic stroke (AIS). mTICI 2c and mTICI 3 are conventionally accepted as successful recanalization. Aim: We investigated whether pre-stroke CHA2DS2-VASc score is associated with mTICI recanalization score in AIS patients with and without AF undergoing percutaneous thrombectomy.

Material and methods
One hundred fifty-nine patients with the diagnosis of AIS who were admitted within 6 hours from symptom onset were included in the study (mean age: 65.7 ±12.9). All subjects underwent endovascular treatment. CHA2DS2-VASc scores of the participants were calculated. Subjects were grouped according to mTICI scores achieved after endovascular treatment. mTICI 2c and mTICI 3 were accepted as successful recanalization.

Results
Successful reperfusion was observed in 130 (81.8%) of all patients who underwent endovascular treatment (mTICI flow  2c) and first-pass reperfusion was observed in 107 (67.3%) patients. When the patients with successful (mTICI flow  2c) and unsuccessful (mTICI flow ≤ 2b) reperfusion were divided into groups, no significant difference was observed between the patients in terms of comorbidities such as AF, hypertension, hyperlipidemia, coronary artery disease and cerebrovascular accident history. Patients with unsuccessful reperfusion were older than patients with successful reperfusion (71.4 ±11.2 vs. 64.5 ±13.01, p = 0.006), with a higher CHA2DS2-VASc score (4.1 ±1.5 vs. 3.04 ±1.6, p = 0.002). In addition, the duration of the procedure was longer in the unsuccessful reperfusion group (92.4 ±27.2 min vs. 65.0 ±25.1 min, p < 0.001). CHA2DS2-VASc score significantly correlated with successful recanalization (correlation coefficient; 0.243, p = 0.002). Multivariate logistic regression analysis revealed that only CHA2DS2-VASc score (OR = 1.43, 95% CI: 1.09–1.87, p = 0.006) and procedure time (OR = 1.03, 95% CI: 1.01–1.05, p < 0.001) were independent predictors of successful reperfusion. The receiver-operating characteristic (ROC) curve was used to determine the cut-off value for the CHA2DS2-VASc score that best predicts successful reperfusion. The optimal threshold was 3.5, with a sensitivity of 58.6% and specificity of 59.2% (area under the curve (AUC): 0.669, p = 0.005).

Conclusions
For the first time in the literature, we investigated and demonstrated that pre-stroke CHA2DS2-VASc score was associated with success of recanalization as assessed with mTICI 2c and mTICI 3 in a cohort of AIS patients regardless of AF presence who underwent endovascular treatment. Our findings deserve to be tested with large scale long term studies.

keywords:

acute ischemic stroke, CHA2DS2-VASc score, endovascular thrombectomy, Modified Thrombolysis in Cerebral Infarction score, mTICI score, atrial fibrillation

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