A prognostic scoring system in patients undergoing mechanical thrombectomy for middle cerebral artery occlusion: Danger bells

INTRODUCTION AND AIM: This study aims to prospectively collect data from patients undergoing mechanical thrombectomy for acute middle cerebral artery (MCA) occlusion and evaluate the severity of stroke at admission, ASPECT scores, demographic characteristics, risk factors, and laboratory values together to develop a novel scoring system. Additionally, the study seeks to determine whether there is an association between this scoring system and clinical outcomes. MATERIALS AND METHODS: The study was approved by the Local Ethics Committee of Samsun University Faculty of Medicine (2023/20/3). Patients aged between 18–82 years, presenting within the first 6 hours of symptom onset, with MCA M1 occlusion who underwent successful mechanical thrombectomy were prospectively included in the study. Data including stroke severity at admission, CT-ASPECT scores, demographic information, risk factors, and laboratory parameters were recorded. The primary outcome assessment was based on the modified Rankin Scale (mRS) at day 90. All data were analyzed using univariate and multivariate logistic regression analyses. A scoring system was created based on regression coefficients and evaluated using ROC analysis. Statistical analyses were performed using SPSS software (Version 22.0, SPSS Inc., Chicago, IL, USA). RESULTS:In multivariate logistic regression analysis, age, presence of diabetes mellitus, smoking, high leukocyte count, low hemoglobin levels, elevated glucose levels, and low CT-ASPECT scores were significantly associated with clinical outcomes. Cut-off points were determined for numerical variables, and a scoring system based on regression coefficients was developed. Within this system, high leukocyte count was assigned 2 points, while other variables received 1 point each. This 10-point scoring system, named DANGER BeLLS, demonstrated a sensitivity of 75.9% and specificity of 85.1% for predicting poor clinical outcomes according to ROC analysis. CONCLUSION:The newly developed DANGER BeLLS scoring system is consistent with the existing literature in terms of its components and provides a more comprehensive evaluation with higher sensitivity and specificity compared to current scoring systems. Our findings suggest the need for external validation of this scoring system.