Journal article
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
Journal of the American Heart Association, Vol.13(14), e034948
07/09/2024
DOI: 10.1161/JAHA.124.034948
PMCID: PMC11292751
PMID: 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 and Results 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 interaction <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.
Details
- Title: Subtitle
- 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
- Creators
- James E. Siegler - University of Chicago Medical CenterManisha Koneru - Cooper Medical School of Rowan UniversityMuhammad M. Qureshi - Boston Medical CenterMohamed Doheim - University of Pittsburgh Medical CenterRaul G. Nogueira - University of Pittsburgh Medical CenterNicolas Martinez-Majander - Helsinki University HospitalSimon Nagel - Klinikum LudwigshafenMary Penckofer - Cooper Medical School of Rowan UniversityJelle Demeestere - KU LeuvenVolker Puetz - University Hospital Carl Gustav CarusMarc Ribo - Vall d'Hebron Hospital UniversitariMohamad Abdalkader - Boston Medical CenterJoão Pedro Marto - Hospital de Egas MonizAlhamza R. Al-Bayati - University of Pittsburgh Medical CenterHiroshi Yamagami - University of TsukubaDiogo C. Haussen - Grady Memorial HospitalMarta Olive-Gadea - Vall d'Hebron Hospital UniversitariSimon Winzer - University Hospital Carl Gustav CarusMahmoud H. Mohammaden - Grady Memorial HospitalRobin Lemmens - KU LeuvenKanta Tanaka - National Cerebral and Cardiovascular CenterPekka Virtanen - Helsinki University HospitalAnne Dusart - Hôpital Civil de CharleroiFlavio Bellante - Hôpital Civil de CharleroiDaniel P. O. Kaiser - University Hospital Carl Gustav CarusFrancois Caparros - Centre Hospitalier Universitaire de LilleHilde Henon - Centre Hospitalier Universitaire de LilleJoão Nuno Ramos - Hospital de Egas MonizSantiago Ortega-Gutierrez - Neurology University of Iowa Hospitals and Clinics Iowa City IA USASunil A. Sheth - The University of Texas Health Science Center at HoustonStefania Nannoni - University of CambridgeLieselotte Vandewalle - KU LeuvenJohannes Kaesmacher - University Hospital of BernSergio Salazar-Marioni - The University of Texas Health Science Center at HoustonLiisa Tomppo - Helsinki University HospitalRita Ventura - Hospital de Egas MonizSyed F. Zaidi - University of ToledoMouhammad Jumaa - University of ToledoAlicia C. Castonguay - University of ToledoMilagros Galecio-Castillo - University of IowaAjit S. Puri - University of Massachusetts Chan Medical SchoolAdnan Mujanovic - University Hospital of BernPiers Klein - Boston Medical CenterLiqi Shu - Rhode Island HospitalBehzad Farzin - Centre Hospitalier de l’Université de MontréalHannah Moomey - Boston Medical CenterHesham E. Masoud - State University of New YorkJessica Jesser - University Hospital HeidelbergMarkus A. Möhlenbruch - University Hospital HeidelbergPeter A. Ringleb - University Hospital HeidelbergDaniel Strbian - Helsinki University HospitalOsama O. Zaidat - Bon Secours Mercy HealthShadi Yaghi - Brown UniversityDavide Strambo - University of LausannePatrik Michel - University of LausanneDaniel Roy - Centre Hospitalier de l’Université de MontréalShinichi Yoshimura - Hyogo UniversityKazutaka Uchida - Hyogo UniversityJean Raymond - Centre Hospitalier de l’Université de MontréalThanh N. Nguyen - Boston University
- Resource Type
- Journal article
- Publication Details
- Journal of the American Heart Association, Vol.13(14), e034948
- DOI
- 10.1161/JAHA.124.034948
- PMID
- 38979812
- PMCID
- PMC11292751
- NLM abbreviation
- J Am Heart Assoc
- ISSN
- 2047-9980
- eISSN
- 2047-9980
- Publisher
- WILEY
- Grant note
The CLEAR study was supported by Medtronic and the Society of Vascular and Interventional Neurology pilot grant.
- Language
- English
- Date published
- 07/09/2024
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984656657002771
Metrics
5 Record Views