Background: The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance. Aims: We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset. Methods: We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3–6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC). Results: A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training (n = 1219) and test (n = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816–0.869) in the training set, and 0.820 (95% CI: 0.786–0.854) in the test set. Conclusions: The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.

IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke

Bergui M.;Lafe E.;Petruzzellis M.;Carolei A.;Tassinari T.;
2019

Abstract

Background: The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance. Aims: We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset. Methods: We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3–6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC). Results: A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training (n = 1219) and test (n = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816–0.869) in the training set, and 0.820 (95% CI: 0.786–0.854) in the test set. Conclusions: The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.
1747493019837756
1747493019837756
http://wso.sagepub.com/
Acute stroke therapy; endovascular treatment; nomogram; outcome; thrombectomy; thrombolysis
Cappellari M.; Mangiafico S.; Saia V.; Pracucci G.; Nappini S.; Nencini P.; Konda D.; Sallustio F.; Vallone S.; Zini A.; Bracco S.; Tassi R.; Bergui M.; Cerrato P.; Pitrone A.; Grillo F.; Saletti A.; De Vito A.; Gasparotti R.; Magoni M.; Puglielli E.; Casalena A.; Causin F.; Baracchini C.; Castellan L.; Malfatto L.; Menozzi R.; Scoditti U.; Comelli C.; Duc E.; Comai A.; Franchini E.; Cosottini M.; Mancuso M.; Peschillo S.; De Michele M.; Giorgianni A.; Luisa Delodovici M.; Lafe E.; Denaro M.F.; Burdi N.; Interno S.; Cavasin N.; Critelli A.; Chiumarulo L.; Petruzzellis M.; Doddi M.; Carolei A.; Auteri W.; Petrone A.; Padolecchia R.; Tassinari T.; Pavia M.; Invernizzi P.; Turcato G.; Forlivesi S.; Francesca Maria Ciceri E.; Bonetti B.; Inzitari D.; Toni D.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/1732000
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