Pittsburgh Response to Endovascular therapy (PRE) Score

PRE Score

Age

NIHSS

ASPECTS Score

Glucose

Baseline mRS

Score:–

–

Identifies patients with anterior circulation large vessel occlusion (LVO) strokes likely to benefit from endovascular therapy.

Why Use

Predicts likelihood of good outcome ( mRS 0-2) to better stratify patients for endovascular reperfusion therapy to derive maximum benefit. Simpler than other similar scores, without sacrificing discriminatory power for good outcomes.

When to Use

Patients ≥18 years old, presenting within 8 hours of symptom onset, with anterior circulation (i.e., internal carotid, M1, or M2) LVO stroke.

Formula

PRE Score = Age + (2 × NIHSS ) – (10 × ASPECTS )

Pearls / Pitfalls

The Pittsburgh Response to Endovascular therapy (PRE) Score was developed to identify stroke patients most likely to derive benefit from endovascular reperfusion therapy. Relatively simple to employ. Uses continuous (as opposed to categorical) variables, improving granularity of the score. Incorporates both age in years as well as a measure of mismatch between infarct core and ischemic penumbra (2 × NIHSS – 10 × ASPECTS ) in the equation. Relies on ASPECTS, which has moderate inter-rater reliability. Does not consider pre-stroke physical status. Validated in a trial comparing third generation stent-retrievers with second generation endovascular therapy devices; has yet to be validated in more recent endovascular stroke clinical trials. Does not consider perfusion imaging data that may be used in patient selection.

Management

Patients with PRE Score -24 to +49 are likely to derive the maximum benefit from endovascular reperfusion therapy if successful revascularization, i.e. TICI (Thrombolysis In Cerebral Infarction) grade 2b/3, is achieved. Patients with PRE Score ≥50 are least likely to benefit from endovascular therapy. Rate of good outcome (mRS 0-2) or final infarct size was not affected by TICI grade 2b/3 reperfusion in the PRE Score ≥50 group.

Critical Actions

Use the PRE Score as an adjunct to clinical judgment, not a replacement.

More Information

Interpretation: PRE −24 to +49: Likely to benefit from endovascular therapy if successful revascularization (TICI 2b/3) is achieved. PRE ≥50: Not likely to benefit from endovascular therapy. Figure: Magnitude of benefit for endovascular therapy based on PRE Score. TICI, Thrombolysis In Cerebral Infarction. mRS, Modified Rankin Scale. PRE, Pittsburgh Response to Endovascular therapy. Based on data from Rangaraju 2015 , used with permission from the author.