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.
J Am Heart Assoc
; 13(14): e034948, 2024 Jul 16.
Article
in En
| MEDLINE
| ID: mdl-38979812
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. METHODS ANDRESULTS:
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 Pinteraction<0.001), with greater benefit favoring patients with lower and midrange scores.CONCLUSIONS:
This score is a pragmatic tool that can estimate the probability of a good outcome with EVT in the late window. REGISTRATION URL https//www.Clinicaltrials.gov; Unique identifier NCT04096248.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Thrombectomy
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Endovascular Procedures
Limits:
Aged
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Female
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Humans
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Male
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Middle aged
Language:
En
Journal:
J Am Heart Assoc
Year:
2024
Document type:
Article
Country of publication: