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

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 obse...

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Main Authors: James E. Siegler, Manisha Koneru, Muhammad M. Qureshi, Mohamed Doheim, Raul G. Nogueira, Nicolas Martinez‐Majander, Simon Nagel, Mary Penckofer, Jelle Demeestere, Volker Puetz, Marc Ribo, Mohamad Abdalkader, João Pedro Marto, Alhamza R. Al‐Bayati, Hiroshi Yamagami, Diogo C. Haussen, Marta Olive‐Gadea, Simon Winzer, Mahmoud H. Mohammaden, Robin Lemmens, Kanta Tanaka, Pekka Virtanen, Anne Dusart, Flavio Bellante, Daniel P. O. Kaiser, Francois Caparros, Hilde Henon, João Nuno Ramos, Santiago Ortega‐Gutierrez, Sunil A. Sheth, Stefania Nannoni, Lieselotte Vandewalle, Johannes Kaesmacher, Sergio Salazar‐Marioni, Liisa Tomppo, Rita Ventura, Syed F. Zaidi, Mouhammad Jumaa, Alicia C. Castonguay, Milagros Galecio‐Castillo, Ajit S. Puri, Adnan Mujanovic, Piers Klein, Liqi Shu, Behzad Farzin, Hannah Moomey, Hesham E. Masoud, Jessica Jesser, Markus A. Möhlenbruch, Peter A. Ringleb, Daniel Strbian, Osama O. Zaidat, Shadi Yaghi, Davide Strambo, Patrik Michel, Daniel Roy, Shinichi Yoshimura, Kazutaka Uchida, Jean Raymond, Thanh N. Nguyen
Format: Article
Language:English
Published: Wiley 2024-07-01
Series:Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
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Online Access:https://www.ahajournals.org/doi/10.1161/JAHA.124.034948
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author James E. Siegler
Manisha Koneru
Muhammad M. Qureshi
Mohamed Doheim
Raul G. Nogueira
Nicolas Martinez‐Majander
Simon Nagel
Mary Penckofer
Jelle Demeestere
Volker Puetz
Marc Ribo
Mohamad Abdalkader
João Pedro Marto
Alhamza R. Al‐Bayati
Hiroshi Yamagami
Diogo C. Haussen
Marta Olive‐Gadea
Simon Winzer
Mahmoud H. Mohammaden
Robin Lemmens
Kanta Tanaka
Pekka Virtanen
Anne Dusart
Flavio Bellante
Daniel P. O. Kaiser
Francois Caparros
Hilde Henon
João Nuno Ramos
Santiago Ortega‐Gutierrez
Sunil A. Sheth
Stefania Nannoni
Lieselotte Vandewalle
Johannes Kaesmacher
Sergio Salazar‐Marioni
Liisa Tomppo
Rita Ventura
Syed F. Zaidi
Mouhammad Jumaa
Alicia C. Castonguay
Milagros Galecio‐Castillo
Ajit S. Puri
Adnan Mujanovic
Piers Klein
Liqi Shu
Behzad Farzin
Hannah Moomey
Hesham E. Masoud
Jessica Jesser
Markus A. Möhlenbruch
Peter A. Ringleb
Daniel Strbian
Osama O. Zaidat
Shadi Yaghi
Davide Strambo
Patrik Michel
Daniel Roy
Shinichi Yoshimura
Kazutaka Uchida
Jean Raymond
Thanh N. Nguyen
author_facet James E. Siegler
Manisha Koneru
Muhammad M. Qureshi
Mohamed Doheim
Raul G. Nogueira
Nicolas Martinez‐Majander
Simon Nagel
Mary Penckofer
Jelle Demeestere
Volker Puetz
Marc Ribo
Mohamad Abdalkader
João Pedro Marto
Alhamza R. Al‐Bayati
Hiroshi Yamagami
Diogo C. Haussen
Marta Olive‐Gadea
Simon Winzer
Mahmoud H. Mohammaden
Robin Lemmens
Kanta Tanaka
Pekka Virtanen
Anne Dusart
Flavio Bellante
Daniel P. O. Kaiser
Francois Caparros
Hilde Henon
João Nuno Ramos
Santiago Ortega‐Gutierrez
Sunil A. Sheth
Stefania Nannoni
Lieselotte Vandewalle
Johannes Kaesmacher
Sergio Salazar‐Marioni
Liisa Tomppo
Rita Ventura
Syed F. Zaidi
Mouhammad Jumaa
Alicia C. Castonguay
Milagros Galecio‐Castillo
Ajit S. Puri
Adnan Mujanovic
Piers Klein
Liqi Shu
Behzad Farzin
Hannah Moomey
Hesham E. Masoud
Jessica Jesser
Markus A. Möhlenbruch
Peter A. Ringleb
Daniel Strbian
Osama O. Zaidat
Shadi Yaghi
Davide Strambo
Patrik Michel
Daniel Roy
Shinichi Yoshimura
Kazutaka Uchida
Jean Raymond
Thanh N. Nguyen
author_sort James E. Siegler
collection DOAJ
description 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 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.
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spelling doaj-art-5e0d327e375c42aeb2d287c7ec972de02025-08-20T02:30:54ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-07-01131410.1161/JAHA.124.034948CLEAR Thrombectomy Score: An Index to Estimate the Probability of Good Functional Outcome With or Without Endovascular Treatment in the Late Window for Anterior Circulation OcclusionJames E. Siegler0Manisha Koneru1Muhammad M. Qureshi2Mohamed Doheim3Raul G. Nogueira4Nicolas Martinez‐Majander5Simon Nagel6Mary Penckofer7Jelle Demeestere8Volker Puetz9Marc Ribo10Mohamad Abdalkader11João Pedro Marto12Alhamza R. Al‐Bayati13Hiroshi Yamagami14Diogo C. Haussen15Marta Olive‐Gadea16Simon Winzer17Mahmoud H. Mohammaden18Robin Lemmens19Kanta Tanaka20Pekka Virtanen21Anne Dusart22Flavio Bellante23Daniel P. O. Kaiser24Francois Caparros25Hilde Henon26João Nuno Ramos27Santiago Ortega‐Gutierrez28Sunil A. Sheth29Stefania Nannoni30Lieselotte Vandewalle31Johannes Kaesmacher32Sergio Salazar‐Marioni33Liisa Tomppo34Rita Ventura35Syed F. Zaidi36Mouhammad Jumaa37Alicia C. Castonguay38Milagros Galecio‐Castillo39Ajit S. Puri40Adnan Mujanovic41Piers Klein42Liqi Shu43Behzad Farzin44Hannah Moomey45Hesham E. Masoud46Jessica Jesser47Markus A. Möhlenbruch48Peter A. Ringleb49Daniel Strbian50Osama O. Zaidat51Shadi Yaghi52Davide Strambo53Patrik Michel54Daniel Roy55Shinichi Yoshimura56Kazutaka Uchida57Jean Raymond58Thanh N. Nguyen59University of Chicago Medical Center Chicago IL USACooper Medical School of Rowan University Camden NJ USARadiology, Radiation Oncology Boston Medical Center Boston MA USAUniversity of Pittsburgh Medical Center Pittsburgh PA USAUniversity of Pittsburgh Medical Center Pittsburgh PA USANeurology, Helsinki University Hospital Helsinki FinlandNeurology Klinikum Ludwigshafen Ludwigshafen GermanyCooper Medical School of Rowan University Camden NJ USANeurology Leuven University Hospital Leuven BelgiumNeurology University Hospital Carl Gustav Carus Dresden GermanyNeurology Hospital Vall d’Hebron Barcelona SpainRadiology Boston Medical Center Boston MA USANeurology Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental Lisbon PortugalUniversity of Pittsburgh Medical Center Pittsburgh PA USAStroke Prevention and Treatment Institute of Medicine, University of Tsukuba JapanNeurology Grady Memorial Hospital Atlanta GA USANeurology Hospital Vall d’Hebron Barcelona SpainNeurology University Hospital Carl Gustav Carus Dresden GermanyNeurology Grady Memorial Hospital Atlanta GA USANeurology Leuven University Hospital Leuven BelgiumDivision of Stroke Care Unit National Cerebral and Cardiovascular Center Suita JapanRadiology Helsinki University Hospital Helsinki FinlandNeurology Hôpital Civil Marie Curie Charleroi BelgiumNeurology Hôpital Civil Marie Curie Charleroi BelgiumDresden Neurovascular Center University Hospital Carl Gustav Carus Dresden GermanyNeurology Centre Hospitalier Universitaire de Lille Lille FranceNeurology Centre Hospitalier Universitaire de Lille Lille FranceNeuroradiology Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental Lisbon PortugalNeurology University of Iowa Hospitals and Clinics Iowa City IA USANeurology UTHealth McGovern Medical School Houston TX USAClinical Neurosciences University of Cambridge Cambridge UKNeurology Leuven University Hospital Leuven BelgiumInstitute of Diagnostic and Interventional Neuroradiology University Hospital Bern Bern SwitzerlandNeurology UTHealth McGovern Medical School Houston TX USANeurology, Helsinki University Hospital Helsinki FinlandNeurology Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental Lisbon PortugalNeurology University of Toledo Toledo OH USANeurology University of Toledo Toledo OH USANeurology University of Toledo Toledo OH USANeurology University of Iowa Hospitals and Clinics Iowa City IA USAInterventional Neuroradiology University of Massachusetts Memorial Medical Center Worcester MA USAInstitute of Diagnostic and Interventional Neuroradiology University Hospital Bern Bern SwitzerlandRadiology Boston Medical Center Boston MA USANeurology Rhode Island Hospital, Brown University Providence RI USARadiology Centre Hospitalier de l’Université de Montréal Montreal QC CanadaRadiology Boston Medical Center Boston MA USANeurology State University of New York Syracuse NY USANeuroradiology Heidelberg University Hospital Heidelberg GermanyNeuroradiology Heidelberg University Hospital Heidelberg GermanyNeurology Heidelberg University Hospital Heidelberg GermanyNeurology, Helsinki University Hospital Helsinki FinlandNeuroscience and Stroke Program Bon Secours Mercy Health St. Vincent Hospital Toledo OH USANeurology Rhode Island Hospital, Brown University Providence RI USANeurology Service Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandNeurology Service Lausanne University Hospital and University of Lausanne Lausanne SwitzerlandRadiology Centre Hospitalier de l’Université de Montréal Montreal QC CanadaNeurosurgery Hyogo Medical University Nishinomiya JapanNeurosurgery Hyogo Medical University Nishinomiya JapanRadiology Centre Hospitalier de l’Université de Montréal Montreal QC CanadaRadiology Boston Medical Center Boston MA USABackground 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 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.https://www.ahajournals.org/doi/10.1161/JAHA.124.034948acute strokeendovascular therapylate windowprognosisscorethrombectomy
spellingShingle James E. Siegler
Manisha Koneru
Muhammad M. Qureshi
Mohamed Doheim
Raul G. Nogueira
Nicolas Martinez‐Majander
Simon Nagel
Mary Penckofer
Jelle Demeestere
Volker Puetz
Marc Ribo
Mohamad Abdalkader
João Pedro Marto
Alhamza R. Al‐Bayati
Hiroshi Yamagami
Diogo C. Haussen
Marta Olive‐Gadea
Simon Winzer
Mahmoud H. Mohammaden
Robin Lemmens
Kanta Tanaka
Pekka Virtanen
Anne Dusart
Flavio Bellante
Daniel P. O. Kaiser
Francois Caparros
Hilde Henon
João Nuno Ramos
Santiago Ortega‐Gutierrez
Sunil A. Sheth
Stefania Nannoni
Lieselotte Vandewalle
Johannes Kaesmacher
Sergio Salazar‐Marioni
Liisa Tomppo
Rita Ventura
Syed F. Zaidi
Mouhammad Jumaa
Alicia C. Castonguay
Milagros Galecio‐Castillo
Ajit S. Puri
Adnan Mujanovic
Piers Klein
Liqi Shu
Behzad Farzin
Hannah Moomey
Hesham E. Masoud
Jessica Jesser
Markus A. Möhlenbruch
Peter A. Ringleb
Daniel Strbian
Osama O. Zaidat
Shadi Yaghi
Davide Strambo
Patrik Michel
Daniel Roy
Shinichi Yoshimura
Kazutaka Uchida
Jean Raymond
Thanh N. Nguyen
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: Cardiovascular and Cerebrovascular Disease
acute stroke
endovascular therapy
late window
prognosis
score
thrombectomy
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic acute stroke
endovascular therapy
late window
prognosis
score
thrombectomy
url https://www.ahajournals.org/doi/10.1161/JAHA.124.034948
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