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Abstract

Background

The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance.

Aims

We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset.

Methods

We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3–6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC).

Results

A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training (n = 1219) and test (n = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816–0.869) in the training set, and 0.820 (95% CI: 0.786–0.854) in the test set.

Conclusions

The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.

Keywords

Acute stroke therapy thrombectomy endovascular treatment thrombolysis outcome nomogram

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References

Berkhemer

Fransen

Beumer

, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11–20.

Goyal

Demchuk

Menon

, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019–1030.

Saver

Goyal

Bonafe

, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285–2295.

Campbell

Mitchell

Kleinig

, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009–1018.

Jovin

Chamorro

Cobo

, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296–2306.

Toni

Mangiafico

Agostoni

, et al. Intravenous thrombolysis and intra-arterial interventions in acute ischemic stroke: Italian Stroke Organisation (ISO)-SPREAD guidelines. Int J Stroke 2015; 10: 1119–1129.

Flint

Xiang

Gupta

, et al. THRIVE score predicts outcomes with a third-generation endovascular stroke treatment device in the TREVO-2 trial. Stroke 2013; 44: 3370–3375.

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.

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.

10.

Cappellari

Turcato

Forlivesi

, et al. The START nomogram for individualized prediction of the probability of unfavorable outcome after intravenous thrombolysis for stroke. Int J Stroke 2018; 13: 700–706.

11.

von Elm

Altman

Egger

Pocock

Gotzsche

Vandenbroucke

. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453–1457.

12.

Mistry

Nakawah

, et al. Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis. Stroke 2017; 48: 2450–2456.

13.

Powers

Rabinstein

Ackerson

, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49: e46–e110.

14.

Higashida

Furlan

Roberts

, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003; 34: e109–e137.

15.

Pexman

Barber

Hill

, et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 2001; 22: 1534–1542.

16.

Mangiafico

Saia

Nencini

, et al. Effect of the interaction between recanalization and collateral circulation on functional outcome in acute ischaemic stroke. Interv Neuroradiol 2014; 20: 704–714.

17.

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.

18.

Nogueira

Jadhav

Haussen

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

19.

Jeong

Kim

Choi

, et al. Posttreatment national institutes of health stroke scale is superior to the initial score or thrombolysis in cerebral ischemia for 3-month outcome. Stroke 2018; 49: 938–944.

20.

Ali Raza

Xiang

Jovin

, et al. Pittsburgh response to endovascular therapy score as a pre-treatment prognostic tool: external validation in Trevo2. Int J Stroke 2017; 12: 494–501.

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IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke