CLEAR Thrombectomy Score: An Index to Estimate the Probability of Good Functional Outcome With or Without Endovascular Treatment in the Late Window for Anterior Circulation Occlusion.
Détails
Etat: Public
Version: Final published version
Licence: CC BY-NC-ND 4.0
ID Serval
serval:BIB_5A409F751CFA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
CLEAR Thrombectomy Score: An Index to Estimate the Probability of Good Functional Outcome With or Without Endovascular Treatment in the Late Window for Anterior Circulation Occlusion.
Périodique
Journal of the American Heart Association
ISSN
2047-9980 (Electronic)
ISSN-L
2047-9980
Statut éditorial
Publié
Date de publication
16/07/2024
Peer-reviewed
Oui
Volume
13
Numéro
14
Pages
e034948
Langue
anglais
Notes
Publication types: Journal Article ; Observational Study ; Multicenter Study
Publication Status: ppublish
Publication Status: ppublish
Résumé
With the expanding eligibility for endovascular therapy (EVT) of patients presenting in the late window (6-24 hours after last known well), we aimed to derive a score to predict favorable outcomes associated with EVT versus best medical management.
A multinational observational cohort of patients from the CLEAR (Computed Tomography for Late Endovascular Reperfusion) study with proximal intracranial occlusion (2014-2022) was queried (n=58 sites). Logistic regression analyses were used to derive a 9-point score for predicting good functional outcome (modified Rankin Scale score 0-2 or return to premorbid modified Rankin Scale score) at 90 days, with sensitivity analyses for prespecified subgroups conducted using bootstrapped random forest regressions. Secondary outcomes included 90-day functional independence (modified Rankin Scale score 0-2), poor outcome (modified Rankin Scale score 5-6), and 90-day survival. The score was externally validated with a single-center cohort (2014-2023). Of the 3231 included patients (n=2499 EVT), a 9-point score included age, early computed tomography ischemic changes, and stroke severity, with higher points indicating a higher probability of a good functional outcome. The areas under the curve for the primary outcome among EVT and best medical management subgroups were 0.72 (95% CI, 0.70-0.74) and 0.87 (95% CI, 0.84-0.90), respectively, with similar performance in the external validation cohort (area under the curve, 0.71 [95% CI, 0.66-0.76]). There was a significant interaction between the score and EVT for good functional outcome, functional independence, and poor outcome (all P <sub>interaction</sub> <0.001), with greater benefit favoring patients with lower and midrange scores.
This score is a pragmatic tool that can estimate the probability of a good outcome with EVT in the late window.
URL: https://www.Clinicaltrials.gov; Unique identifier: NCT04096248.
A multinational observational cohort of patients from the CLEAR (Computed Tomography for Late Endovascular Reperfusion) study with proximal intracranial occlusion (2014-2022) was queried (n=58 sites). Logistic regression analyses were used to derive a 9-point score for predicting good functional outcome (modified Rankin Scale score 0-2 or return to premorbid modified Rankin Scale score) at 90 days, with sensitivity analyses for prespecified subgroups conducted using bootstrapped random forest regressions. Secondary outcomes included 90-day functional independence (modified Rankin Scale score 0-2), poor outcome (modified Rankin Scale score 5-6), and 90-day survival. The score was externally validated with a single-center cohort (2014-2023). Of the 3231 included patients (n=2499 EVT), a 9-point score included age, early computed tomography ischemic changes, and stroke severity, with higher points indicating a higher probability of a good functional outcome. The areas under the curve for the primary outcome among EVT and best medical management subgroups were 0.72 (95% CI, 0.70-0.74) and 0.87 (95% CI, 0.84-0.90), respectively, with similar performance in the external validation cohort (area under the curve, 0.71 [95% CI, 0.66-0.76]). There was a significant interaction between the score and EVT for good functional outcome, functional independence, and poor outcome (all P <sub>interaction</sub> <0.001), with greater benefit favoring patients with lower and midrange scores.
This score is a pragmatic tool that can estimate the probability of a good outcome with EVT in the late window.
URL: https://www.Clinicaltrials.gov; Unique identifier: NCT04096248.
Mots-clé
Humans, Male, Female, Endovascular Procedures/methods, Aged, Thrombectomy/methods, Middle Aged, Treatment Outcome, Time Factors, Ischemic Stroke/physiopathology, Ischemic Stroke/therapy, Recovery of Function, Functional Status, Predictive Value of Tests, Risk Assessment/methods, Time-to-Treatment, Tomography, X-Ray Computed, acute stroke, endovascular therapy, late window, prognosis, score, thrombectomy
Pubmed
Open Access
Oui
Création de la notice
12/07/2024 12:55
Dernière modification de la notice
20/07/2024 7:12