CardioVascular and Interventional Radiology

, Volume 36, Issue 5, pp 1241–1246 | Cite as

Neurointerventional Treatment in Acute Stroke. Whom to Treat? (Endovascular Treatment for Acute Stroke: Utility of THRIVE Score and HIAT Score for Patient Selection)

  • Lars Fjetland
  • Sumit Roy
  • Kathinka D. Kurz
  • Tore Solbakken
  • Jan Petter Larsen
  • Martin W. Kurz
Clinical Investigation



Intra-arterial therapy (IAT) is used increasingly as a treatment option for acute stroke caused by central large vessel occlusions. Despite high rates of recanalization, the clinical outcome is highly variable. The authors evaluated the Houston IAT (HIAT) and the totaled health risks in vascular events (THRIVE) score, two predicting scores designed to identify patients likely to benefit from IAT.


Fifty-two patients treated at the Stavanger University Hospital with IAT from May 2009 to June 2012 were included in this study. We combined the scores in an additional analysis. We also performed an additional analysis according to high age and evaluated the scores in respect of technical efficacy.


Fifty-two patients were evaluated by the THRIVE score and 51 by the HIAT score. We found a strong correlation between the level of predicted risk and the actual clinical outcome (THRIVE p = 0.002, HIAT p = 0.003). The correlations were limited to patients successfully recanalized and to patients <80 years. By combining the scores additional 14.3 % of the patients could be identified as poor candidates for IAT. Both scores were insufficient to identify patients with a good clinical outcome.


Both scores showed a strong correlation to poor clinical outcome in patients <80 years. The specificity of the scores could be enhanced by combining them. Both scores were insufficient to identify patients with a good clinical outcome and showed no association to clinical outcome in patients aged ≥80 years.


Neurointerventions Endovascular treatment Stroke therapy Thrombectomy Thrombolysis Brain/neurological/nervous system Stroke 


Conflict of interest

Martin W. Kurz has received payment for lectures from Bayer Health Care and Boehringer Ingelheim. Jan Petter Larsen has received payment for lectures from Lundbeck Pharma and is a board member of the same company. The other authors declare that they have no conflict of interest.


  1. 1.
    Lloyd-Jones D, Adams R et al (2009) Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119(3):480–486PubMedCrossRefGoogle Scholar
  2. 2.
    Hatano S (1976) Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 54(5):541–553PubMedGoogle Scholar
  3. 3.
    Thrift AG, Dewey HM, Macdonell RA et al (2001) Incidence of the major stroke subtypes: initial findings from the North East Melbourne stroke incidence study (NEMESIS). Stroke 32(8):1732–1738PubMedCrossRefGoogle Scholar
  4. 4.
    Kolominsky-Rabas PL, Sarti C, Heuschmann PU et al (1998) A prospective community-based study of stroke in Germany—The Erlangen Stroke Project (ESPro): incidence and case fatality at 1, 3, and 12 months. Stroke 29(12):2501–2506PubMedCrossRefGoogle Scholar
  5. 5.
    Lansberg MG, Bluhmki E et al (2009) Efficacy and safety of tissue plasminogen activator 3 to 4.5 hours after acute ischemic stroke: a metaanalysis. Stroke 40(7):2438–2441PubMedCrossRefGoogle Scholar
  6. 6.
    Saqqur M, Uchino K et al (2007) Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38(3):948–954PubMedCrossRefGoogle Scholar
  7. 7.
    Cohen JE, Gomori JM, Leker RR et al (2012) Recanalization with stent-based mechanical thrombectomy in anterior circulation major ischemic stroke. J Clin Neurosci 19(1):39–43PubMedCrossRefGoogle Scholar
  8. 8.
    IMS Study Investigators (2004) Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the interventional management of stroke study. Stroke 35(4):904–911CrossRefGoogle Scholar
  9. 9.
    Machi P, Costalat V et al (2012) Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg 4(1):62–66PubMedCrossRefGoogle Scholar
  10. 10.
    Smith WS, Sung G et al (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36(7):1432–1438PubMedCrossRefGoogle Scholar
  11. 11.
    Shaltoni HM, Albright KC et al (2007) Is intra-arterial thrombolysis safe after full-dose intravenous recombinant tissue plasminogen activator for acute ischemic stroke? Stroke 38(1):80–84PubMedCrossRefGoogle Scholar
  12. 12.
    Lisboa RC, Jovanovic BD et al (2002) Analysis of the safety and efficacy of intra-arterial thrombolytic therapy in ischemic stroke. Stroke 33(12):2866–2871PubMedCrossRefGoogle Scholar
  13. 13.
    Hallevi H, Barreto AD et al (2009) Identifying patients at high risk for poor outcome after intra-arterial therapy for acute ischemic stroke. Stroke 40(5):1780–1785PubMedCrossRefGoogle Scholar
  14. 14.
    Fjetland L, Roy S et al (2012) Endovascular acute stroke treatment performed by vascular interventional radiologists: is it safe and efficacious? Cardiovasc Intervent Radiol 35(5):1029–1035PubMedCrossRefGoogle Scholar
  15. 15.
    Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38(3):967–973PubMedCrossRefGoogle Scholar
  16. 16.
    Zeevi N, Kuchel GA et al (2012) Interventional stroke therapies in the elderly: are we helping? AJNR Am J Neuroradiol 33(4):638–642PubMedCrossRefGoogle Scholar
  17. 17.
    Brinjikji W, Rabinstein AA et al (2011) Patient outcomes with endovascular embolectomy therapy for acute ischemic stroke: a study of the national inpatient sample: 2006 to 2008. Stroke 42(6):1648–1652PubMedCrossRefGoogle Scholar
  18. 18.
    Flint AC, Cullen SP et al (2010) Predicting long-term outcome after endovascular stroke treatment: the totaled health risks in vascular events score. AJNR Am J Neuroradiol 31(7):1192–1196PubMedCrossRefGoogle Scholar
  19. 19.
    Costalat V, Lobotesis K et al (2012) Prognostic factors related to clinical outcome following thrombectomy in ischemic stroke (RECOST Study). 50 patients prospective study. Eur J Radiol 81(2):4075–4082PubMedCrossRefGoogle Scholar
  20. 20.
    Ringelstein EB, Biniek R et al (1992) Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization. Neurology 42(2):289–298PubMedCrossRefGoogle Scholar
  21. 21.
    Khatri P, Abruzzo T et al (2009) Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology 73(13):1066–1072PubMedCrossRefGoogle Scholar
  22. 22.
    Tan ML, Mitchell P et al (2012) Shorter time to intervention improves recanalization success and clinical outcome post intra-arterial intervention for basilar artery thrombosis. J Clin Neurosci 19(10):1397–1400PubMedCrossRefGoogle Scholar
  23. 23.
    TIMI Study Group (1985) The thrombolysis in myocardial infarction (TIMI) trial. Phase I findings. N Engl J Med 312(14):932–936CrossRefGoogle Scholar
  24. 24.
    Khatri P, Neff J et al (2005) Revascularization end points in stroke interventional trials: recanalization versus reperfusion in IMS-I. Stroke 36(11):2400–2403PubMedCrossRefGoogle Scholar
  25. 25.
    Bill O, Zufferey P et al (2012) Severe stroke: patient profile and predictors of favourable outcome. J Thromb Haemost. doi: 10.1111/jth.12066 [Epub ahead of print]Google Scholar
  26. 26.
    Brott T, Adams HP, Olinger CP et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. 20:864–870Google Scholar
  27. 27.
    van Swieten JC, Koudstaal PJ et al (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19(5):604–607PubMedCrossRefGoogle Scholar
  28. 28.
    Ishkanian AA, McCullough-Hicks ME et al (2011) Improving patient selection for endovascular treatment of acute cerebral ischemia: a review of the literature and an external validation of the Houston IAT and THRIVE predictive scoring systems. Neurosurg Focus 30(6):E7PubMedCrossRefGoogle Scholar
  29. 29.
    Forti P et al (2012) Independent predictors of ischemic stroke in the elderly: prospective data from a stroke unit. Neurology 80(1):29–38PubMedCrossRefGoogle Scholar
  30. 30.
    Smith WS, Sung G et al (2008) Mechanical thrombectomy for acute ischemic stroke: final results of the multi MERCI trial. Stroke 39(4):1205–1212PubMedCrossRefGoogle Scholar
  31. 31.
    Howard G, Goff DC (2012) Population shifts and the future of stroke: forecasts of the future burden of stroke. Ann N Y Acad Sci 1268:14–20. doi: 10.1111/j.1749-6632.2012.06665.x PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Lars Fjetland
    • 1
    • 2
  • Sumit Roy
    • 1
  • Kathinka D. Kurz
    • 1
  • Tore Solbakken
    • 3
  • Jan Petter Larsen
    • 2
    • 3
  • Martin W. Kurz
    • 2
    • 3
  1. 1.Department of RadiologyStavanger University HospitalStavangerNorway
  2. 2.The Norwegian Center for Movement Disorders, Stavanger University HospitalStavangerNorway
  3. 3.Department of NeurologyStavanger University HospitalStavangerNorway

Personalised recommendations