The 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

Research output: Preprint/Documentation/ReportPreprint

Contributors

  • James E. Siegler - (Author)
  • Volker Puetz - , Department of Neurology, Dresden Neurovascular Center (Author)
  • Marc Ribo - (Author)
  • Mohamad Abdalkader - (Author)
  • João Marto - (Author)
  • Alhamza R. Al-Bayati - (Author)
  • Hiroshi Yamagami - (Author)
  • Diogo C. Haussen - (Author)
  • Marta Olivé-Gadea - (Author)
  • Simon Winzer - , Institute for Immunology (Author)
  • Mahmoud Mohammaden - (Author)
  • Manisha Koneru - (Author)
  • Robin Lemmens - (Author)
  • Kanta Tanaka - (Author)
  • Pekka Virtanen - (Author)
  • Anne Dusart - (Author)
  • Flavio Bellante - (Author)
  • Daniel P. O. Kaiser - , Institute and Polyclinic of Diagnostic and Interventional Neuroradiology (Author)
  • Francois Caparros - (Author)
  • Hilde Henon - (Author)
  • João Nuno Ramos - (Author)
  • Santiago Ortega-Gutierrez - (Author)
  • Muhammad M. Qureshi - (Author)
  • Sunil A. Sheth - (Author)
  • Stefania Nannoni - (Author)
  • Lieselotte Vandewalle - (Author)
  • Johannes Kaesmacher - (Author)
  • Sergio Salazar-Marioni - (Author)
  • Liisa Tomppo - (Author)
  • Rita Ventura - (Author)
  • Syed F. Zaidi - (Author)
  • Mouhammad A. Jumaa - (Author)
  • Alicia C. Castonguay - (Author)
  • Mohamed Doheim - (Author)
  • Milagros Galecio-Castillo - (Author)
  • Ajit S. Puri - (Author)
  • Adnan Mujanovic - (Author)
  • Piers Klein - (Author)
  • Liqi Shu - (Author)
  • Behzad Farzin - (Author)
  • Hannah Moomey - (Author)
  • Hesham E. Masoud - (Author)
  • Jessica Jesser - (Author)
  • Markus Mohlenbruch - (Author)
  • Raul G. Nogueira - (Author)
  • Peter A. Ringleb - (Author)
  • Daniel Strebian - (Author)
  • Osama O. Zaidat - (Author)
  • Shadi Yaghi - (Author)
  • Davide Strambo - (Author)
  • Patrik Michel - (Author)
  • Daniel Roy - (Author)
  • Shinichi Yoshimura - (Author)
  • Kazutaka Uchida - (Author)
  • Jean Raymond - (Author)
  • Nicolas Martinez-Majander - (Author)
  • Thanh N. Nguyen - (Author)
  • Simon Nagel - (Author)
  • Mary Penckofer - (Author)
  • Jelle Demeestere - (Author)

Abstract

Background: 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 (BMM). Such a scale could be used to identify patients likely or unlikely to benefit from EVT in the late window. Methods: The multinational Computed Tomography for Late Endovascular Reperfusion (CLEAR) observational cohort of consecutive patients with acute proximal intracranial occlusion (2014-2022) was queried (n=58 sites). Logistic regression analyses were used to derive an 8-point score for predicting good functional outcome (mRS 0-2 or return to premorbid mRS) at 90 days, with sensitivity analyses for pre-specified subgroups conducted using bootstrapped random forest regressions and was externally validated with a single center cohort (2014-2023). Secondary outcomes included 90-day functional independence (mRS 0-2), symptomatic intracranial hemorrhage (sICH), poor outcome (mRS 5-6), and 90-day survival. Findings: Of the 3231 included patients (n=2499 treated with EVT), an 8-point CLEAR score included age, ASPECTS, and National Institutes of Health Stroke Scale (NIHSS), with higher points indicating a higher probability of a good functional outcome. The areas under the curve (AUC) for the primary outcome among EVT and BMM subgroups were 0·72 (95% confidence interval [CI]: 0·70-0·74) and 0·87 (95% CI: 0·84-0·90), respectively, with similar performance in the external validation cohort (AUC 0·71, 95% CI: 0·66-0·76). There was a significant interaction between CLEAR score and EVT treatment for good functional outcome, functional independence, and poor outcome (all pinteraction <0·001), with greater benefit favoring patients with lower and mid-range CLEAR scores. Interpretation: The CLEAR Thrombectomy Success Score is a pragmatic tool that can estimate the probability of a good outcome in patients treated with EVT versus BMM in the late window for proximal anterior circulation occlusion. Funding: Medtronic.

Details

Original languageGerman
Publication statusPublished - 5 Feb 2024
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External IDs

ORCID /0000-0001-5258-0025/work/152545521