Noninvasive Qureshi Grading Scheme Predicts 90-Day mRS in Patients with Acute Ischemic Stroke.

Shin, Dong-Ick; Lee, Hyung-Suk; Baek, Shin-Hye; Lee, Sang-Soo; Lee, Sung Hyun; Saver, Jeffrey L; Liebeskind, David S

BACKGROUND The Qureshi grading scheme is an effective classification system for evaluating the severity of acute arterial occlusion. However, this scheme is of limited utility because it is based on invasive angiography. In this study, we assessed whether a relationship between a noninvasive Qureshi score, based on magnetic resonance angiography (MRA) or computed tomography angiography (CTA), and 90-day functional outcome could be observed in patients with acute ischemic stroke. METHODS A stroke neurologist evaluated all patients with acute ischemic stroke who presented to the emergency room within 12 hour of symptom onset. Two neurologists independently assessed the noninvasive Qureshi score from initial MRA or CTA. We assessed the relationship between the noninvasive Qureshi grading scheme and clinical outcome on day 90. RESULTS Of a total 125 patients, 75 underwent MRA and 50 underwent CTA. Interobserver reliability showed good agreement (κ = .62). The noninvasive Qureshi score for MRA or CTA and that for CTA alone were directly associated with a good 90-day functional outcome (odds ratio, .672; P = .016 and odds ratio, .511; P = .042). CONCLUSIONS The noninvasive Qureshi scheme using MRA or CTA provides meaningful information about long-term functional outcomes in patients with acute ischemic stroke.