Aims: The Hunter-8 and the ACT-FAST are stroke scales used in Australia for the pre-hospital identification of large vessel occlusion (LVO) stroke but have not previously been compared. Moreover, their use in identifying distal arterial occlusions has not previously been assessed. We therefore aimed to describe the area under the receiver operating curve (AUC) of the Hunter-8 versus the ACT-FAST for the detection of classic LVO.
Methods: Both scales were performed on consecutive patients presenting with stroke-like symptoms within 24 hours of symptom onset presenting to the emergency department at a tertiary referral hospital between June 2018 and January 2019. The AUC of the Hunter-8 and the ACT-FAST was calculated for the detection of LVO using different definitions [classic LVO (proximal segment of the middle cerebral artery (MCA-M1), terminal internal carotid artery (T-ICA), or tandem occlusions) and extended LVO (classic LVO plus proximal MCA-M2 and basilar occlusions)].
Results: Of 126 suspected stroke patients, there were 24 classic LVO and 34 extended LVO. For detection of classic LVO, the Hunter-8 had an AUC of 0.79 and the ACT-FAST had an AUC of 0.77. For extended LVO, the AUC was 0.71 and 0.70 respectively.
Conclusion: Both scales represent a significant opportunity to identify patients with proven potential benefit from thrombectomy (classic LVO), however M2 and basilar occlusions may be more challenging to identify with these scales.
Malhotra K, Gornbein J, Saver JL. Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: a review. Front Neurol 2017;8:651.
Hernández‐Pérez M, Perez de la Ossa N, Aleu A, Millán M, Gomis M, Dorado L, et al. Natural history of acute stroke due to occlusion of the middle cerebral artery and intracranial internal carotid artery. J Neuroimaging 2014;24:354–8.
Berkhemer OA, Fransen PS, Beumer D, Van Den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20.
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019–30.
Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95.
Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009–18.
Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306.
Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11–21.
Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708–18.
Demeestere J, Garcia-Esperon C, Lin L, Bivard A, Ang T, Smoll NR, et al. Validation of the National Institutes of Health Stroke Scale-8 to detect large vessel occlusion in ischemic stroke. J Stroke Cerebrovasc Dis 2017;26:1419–26.
Zhao H, Pesavento L, Coote S, Rodrigues E, Salvaris P, Smith K, et al. Ambulance clinical triage for acute stroke treatment: paramedic triage algorithm for large vessel occlusion. Stroke 2018;49:945–51.
Sweid A, Hammoud B, Ramesh S, Wong D, Alexander T, Weinberg J, et al. Acute ischaemic stroke interventions: large vessel occlusion and beyond. Stroke Vasc Neurol 2020;5. http://dx.doi.org/10.1136/svn-2019-000262.
Demeestere J, Garcia-Esperon C, Garcia-Bermejo P, Ombelet F, McElduff P, Bivard A, et al. Evaluation of hyperacute infarct volume using ASPECTS and brain CT perfusion core volume. Neurology 2017;88:2248–53.
Duvekot MH, Venema E, Rozeman AD, Moudrous W, Vermeij FH, Biekart M, et al. Comparison of eight prehospital stroke scales to detect intracranial large-vessel occlusion in suspected stroke (PRESTO): a prospective observational study. Lancet Neurol 2021;20:213–21.
Demel SL, Broderick JP. Basilar occlusion syndromes: an update. Neurohospitalist 2015;5:142–50.
Shapiro M, Raz E, Nossek E, Chancellor B, Ishida K, Nelson PK. Neuroanatomy of the middle cerebral artery: implications for thrombectomy. J Neurointerv Surg 2020;12:768–73.
Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723–31.
de Leciñana MA, Kawiorski MM, Ximénez-Carrillo Á, Cruz-Culebras A, García-Pastor A, Martínez-Sánchez P, et al. Mechanical thrombectomy for basilar artery thrombosis: a comparison of outcomes with anterior circulation occlusions. J Neurointerv Surg 2017;9:1173–8.