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Abstract

Background

The Charlotte large artery occlusion endovascular therapy outcome score (CLEOS) predicts poor 90-day outcomes for patients presenting with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions. It incorporates RAPID-derived cerebral blood volume (CBV) index, a marker of collateral circulation. We validated the predictive ability of CLEOS with Viz.ai-processed computed tomography perfusion (CTP) imaging.

Methods

The original CLEOS derivation cohort was compared to a validation cohort consisting of all ICA and MCA thrombectomy patients treated at a large health system with Viz.ai-processed CTP. Rates of poor 90-day outcome (mRS 4–6) were compared in the derivation and validation cohorts, stratified by CLEOS. CLEOS was compared to previously described prediction models using area under the curve (AUC) analyses. Calibration of CLEOS was performed to compare predicted risk of poor outcomes with observed outcomes.

Results

One-hundred eighty-one patients (mean age 66.4 years, median NIHSS 16) in the validation cohort were included. The validation cohort had higher median CTP core volumes (24 vs 8 ml) and smaller median mismatch volumes (81 vs 101 ml) than the derivation cohort. CLEOS-predicted poor outcomes strongly correlated with observed outcomes (R² = 0.82). AUC for CLEOS in the validation cohort (0.72, 95% CI 0.64–0.80) was similar to the derivation cohort (AUC 0.75, 95% CI 0.70–0.80) and was comparable or superior to previously described prognostic models.

Conclusions

CLEOS can predict risk of poor 90-day outcomes in ICA and MCA thrombectomy patients evaluated with pre-intervention, Viz.ai-processed CTP.

Keywords

Stroke thrombectomy CT perfusion outcome prediction

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References

Powers

Rabinstein

Ackerson

, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019 Oct 30; 50: e344–e418.

Goyal

Menon

van Zwam

, et al., HERMES Collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731.

Albers

Marks

Kemp

, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378: 708–718.

Nogueira

Jadhav

Haussen

, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct [Internet]. N Engl J Med 2018; 378: 11–21.

Karamchandani

Prasad

Strong

, et al. A tool to improve stroke outcome prediction: the Charlotte large artery occlusion endovascular therapy outcome score. J Stroke Cerebrovasc Dis 2022; 31: 106393.

Straka

Albers

Bammer

. Real-time diffusion-perfusion mismatch analysis in acute stroke [Internet]. J Magn Reson Imaging 2010; 32: 1024–1037.

MacLellan

Mlynash

Kemp

, et al. Perfusion imaging collateral scores predict infarct growth in non-reperfused DEFUSE 3 patients. J Stroke Cerebrovasc Dis 2021; 31: 106208.

Rao

Mlynash

Christensen

, et al. Collateral status contributes to differences between observed and predicted 24-h infarct volumes in DEFUSE 3. J Cereb Blood Flow Metab 2020; 40: 1966–1974.

Arenillas

Cortijo

García-Bermejo

, et al. Relative cerebral blood volume is associated with collateral status and infarct growth in stroke patients in SWIFT PRIME [Internet]. J Cereb Blood Flow Metab 2018; 38: 1839–1847.

10.

Karamchandani

Strong

Rhoten

, et al. Cerebral blood volume index as a predictor of functional independence after basilar artery thrombectomy. J Neuroimaging 2022; 32: 171–178.

11.

Murray

Unberath

Hager

, et al. Artificial intelligence to diagnose ischemic stroke and identify large vessel occlusions: a systematic review. J Neurointerv Surg 2020; 12: 156–164.

12.

van Swieten

Koudstaal

Visser

, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19: 604–607.

13.

Hacke

Kaste

Fieschi

, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998; 352: 1245–1251.

14.

Voleti

Aziz

Vidovich

, et al. Association between CT angiogram collaterals and CT perfusion in delayed time windows for large vessel occlusion ischemic strokes [Internet]. J Stroke Cerebrovasc Dis 2022; 31: 106263.

15.

Wang

C-M

Chang

Y-M

Sung

P-S

, et al. Hypoperfusion index ratio as a surrogate of collateral scoring on CT angiogram in large vessel stroke. J Clin Med Res 2021; 10: 1296.

16.

Hoglund

Strong

Rhoten

, et al. Test characteristics of a 5–element cortical screen for identifying anterior circulation large vessel occlusion ischemic strokes. J Am Coll Emerg Physicians Open 2020; 1: 908–917.

17.

Jang

Nam

, et al. Thrombolysis in cerebral infarction grade 2C or 3 represents a better outcome than 2B for endovascular thrombectomy in acute ischemic stroke: a network meta-analysis. World Neurosurg 2020; 136: e419–e439.

18.

Sarraj

Albright

Barreto

, et al. Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke. Stroke 2013; 44: 3324–3330.

19.

Rangaraju

Aghaebrahim

Streib

, et al. Pittsburgh response to endovascular therapy (PRE) score: optimizing patient selection for endovascular therapy for large vessel occlusion strokes. J Neurointerv Surg 2015; 7: 783–788.

20.

Saposnik

Guzik

Reeves

, et al. Stroke prognostication using age and NIH stroke scale: SPAN-100 [Internet]. Neurology 2013; 80: 21–28.

21.

Kobkitsuksakul

, Division of Interventional Neuroradiology, Department of Diagnostic and therapeutic Radiology, Ramathibodi Hospital, Mahidol University School of Medicine, Bangkok, et al. Interobserver agreement between senior radiology resident, neuroradiology fellow, and experienced neuroradiologist in the rating of Alberta Stroke Program Early Computed Tomography Score (ASPECTS). Diagn Interv Radiol 2018; 24: 104–107.

22.

McTaggart

Jovin

Lansberg

, et al. Alberta stroke program early computed tomographic scoring performance in a series of patients undergoing computed tomography and MRI: reader agreement, modality agreement, and outcome prediction. Stroke 2015; 46: 407–412.

23.

van Horn

Kniep

Broocks

, et al. ASPECTS interobserver agreement of 100 investigators from the TENSION study. Clin Neuroradiol 2021; 31: 1093–1100.

24.

Schloss

Tversky

Katz

, et al. Early palliative care consultation decreases length of stay in severe stroke patients (P1.211). Neurology 2017; 88: P1.211.

25.

Holloway

Arnold

Creutzfeldt

, et al. Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 1887–1916.

26.

Comer

Williams

Bartlett

, et al. Palliative and end-of-life care after severe stroke. J Pain Symptom Manage 2022; 63: 721–728.

27.

Flint

Rao

Chan

, et al. Improved ischemic stroke outcome prediction using model estimation of outcome probability: the THRIVE-c calculation. Int J Stroke 2015; 10: 815–821.

28.

Venema

Mulder

MJH

Roozenbeek

, et al. Selection of patients for intra-arterial treatment for acute ischaemic stroke: development and validation of a clinical decision tool in two randomised trials. Br Med J 2017; 357: j1710.

29.

Kremers

Venema

Duvekot

, et al. Outcome prediction models for endovascular treatment of ischemic stroke: systematic review and external validation. Stroke 2022; 53: 825–836.

30.

Raza

Rangaraju

. A review of pre-intervention prognostic scores for early prognostication and patient selection in endovascular management of large vessel occlusion stroke. Interv Neurol 2018; 7: 171–181.

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Validation of the Charlotte large artery occlusion endovascular therapy outcome score using Viz.ai-derived cerebral blood volume index

Abstract

Background

Methods

Results

Conclusions

Keywords

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References

Supplementary Material