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July 31, 2023 article Open access Aachen paper

Development and Validation of a Postprocedural Model to Predict Outcome After Endovascular Treatment for Ischemic Stroke

JAMA Neurology, vol. 80, pp. 940

DOI: 10.1001/jamaneurol.2023.2392 Full text (OA) OpenAlex

Abstract

Importance: Outcome prediction after endovascular treatment (EVT) for ischemic stroke is important to patients, family members, and physicians. Objective: To develop and validate a model based on preprocedural and postprocedural characteristics to predict functional outcome for individual patients after EVT. Design, Setting, and Participants: A prediction model was developed using individual patient data from 7 randomized clinical trials, performed between December 2010 and December 2014. The model was developed within the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) collaboration and external validation in data from the Dutch Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry of patients treated in clinical practice between March 2014 and November 2017. Participants included patients from multiple centers throughout different countries in Europe, North America, East Asia, and Oceania (derivation cohort), and multiple centers in the Netherlands (validation cohort). Included were adult patients with a history of ischemic stroke from an intracranial large vessel occlusion in the anterior circulation who underwent EVT within 12 hours of symptom onset or last seen well. Data were last analyzed in July 2022. Main Outcome(s) and Measure(s): A total of 19 variables were assessed by multivariable ordinal regression to predict functional outcome (modified Rankin Scale [mRS] score) 90 days after EVT. Variables were routinely available 1 day after EVT. Akaike information criterion (AIC) was used to optimize model fit vs model complexity. Probabilities for functional independence (mRS 0-2) and survival (mRS 0-5) were derived from the ordinal model. Model performance was expressed with discrimination (C statistic) and calibration. Results: A total of 781 patients (median [IQR] age, 67 [57-76] years; 414 men [53%]) constituted the derivation cohort, and 3260 patients (median [IQR] age, 72 [61-80] years; 1684 men [52%]) composed the validation cohort. Nine variables were included in the model: age, baseline National Institutes of Health Stroke Scale (NIHSS) score, prestroke mRS score, history of diabetes, occlusion location, collateral score, reperfusion grade, NIHSS score at 24 hours, and symptomatic intracranial hemorrhage 24 hours after EVT. External validation in the MR CLEAN Registry showed excellent discriminative ability for functional independence (C statistic, 0.91; 95% CI, 0.90-0.92) and survival (0.89; 95% CI, 0.88-0.90). The proportion of functional independence in the MR CLEAN Registry was systematically higher than predicted by the model (41% vs 34%), whereas observed and predicted survival were similar (72% vs 75%). The model was updated and implemented for clinical use. Conclusion and relevance: The prognostic tool MR PREDICTS@24H can be applied 1 day after EVT to accurately predict functional outcome for individual patients at 90 days and to provide reliable outcome expectations and personalize follow-up and rehabilitation plans. It will need further validation and updating for contemporary patients.

Authors 93

  1. Vicky Chalos

    Erasmus MC · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  2. Esmée Venema

    Erasmus MC · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Emergency Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  3. Maxim J.H.L. Mulder

    Erasmus MC · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  4. Bob Roozenbeek

    Erasmus MC · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  5. Ewout Willem Steyerberg Aachen Department of Biomedical Data Sciences

    Leiden University Medical Center · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  6. Marieke J.H. Wermer Aachen Department of Neurology, Leiden University Medical Center (LUMC)

    Leiden University Medical Center · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  7. Geert J. Lycklama à Nijeholt

    Medisch Centrum Haaglanden · Health and Education Research Management and Epidemiologic Services (United States) · Stichting Haaglanden Medisch Centrum

    Affiliation as printed

    Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  8. H. Bart van der Worp

    Utrecht University · University Medical Center Utrecht · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Neurology and Neurosurgery, University Medical Center Utrecht, Brain Center, Utrecht University, Utrecht, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  9. Mayank Goyal

    University of Calgary · Health and Education Research Management and Epidemiologic Services (United States) · Hotchkiss Brain Institute

    Affiliation as printed

    Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  10. Bruce C.V. Campbell

    The Royal Melbourne Hospital · The University of Melbourne · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  11. Keith W. Muir

    Health and Education Research Management and Epidemiologic Services (United States) · Queen Elizabeth University Hospital · University of Glasgow

    Affiliation as printed

    Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, United Kingdom

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  12. Françis Guillemin

    Inserm · Centre Hospitalier Régional et Universitaire de Nancy · Health and Education Research Management and Epidemiologic Services (United States) · Université de Lorraine

    Affiliation as printed

    CHRU Nancy, Inserm, Université de Lorraine, CIC Clinical Epidemiology, Nancy, France

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  13. Serge Bracard

    Centre Hospitalier Régional et Universitaire de Nancy · Health and Education Research Management and Epidemiologic Services (United States) · Université de Lorraine

    Affiliation as printed

    Department of Diagnostic and Interventional Neuroradiology, University of Lorraine and University Hospital of Nancy, Nancy, France

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  14. Phil White

    Health and Education Research Management and Epidemiologic Services (United States) · Newcastle University

    Affiliation as printed

    Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  15. Antoni Dávalos

    Health and Education Research Management and Epidemiologic Services (United States) · Hospital Universitari Germans Trias i Pujol

    Affiliation as printed

    Department of Neuroscience, Hospital Germans Trias y Pujol, Barcelona, Spain

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  16. Tudor G. Jovin

    UPMC Presbyterian · University of Pittsburgh Medical Center · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, Presbyterian University Hospital, Pittsburgh, Pennsylvania

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  17. Michael D. Hill

    University of Calgary · Health and Education Research Management and Epidemiologic Services (United States) · Hotchkiss Brain Institute

    Affiliation as printed

    Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  18. Peter John Mitchell

    The Royal Melbourne Hospital · The University of Melbourne · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  19. Andrew M. Demchuk

    University of Calgary · Health and Education Research Management and Epidemiologic Services (United States) · Hotchkiss Brain Institute

    Affiliation as printed

    Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  20. Jeffrey L. Saver

    University of California, Los Angeles · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of Los Angeles, Los Angeles, California

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  21. Aad van der Lugt

    Erasmus MC · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  22. Scott Brown
    Affiliation as printed

    Altair Biostatistics, Mooresville, North Carolina

  23. Diederik W.J. Dippel

    Erasmus MC · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  24. Hester Floor Lingsma

    Erasmus MC · Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  25. Olvert A. Berkhemer

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  26. Puck S. S. Fransen

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  27. Debbie Beumer

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  28. Lucie A. van den Berg

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  29. Albert J. Yoo

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  30. Wouter J. Schonewille

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  31. Jan Albert Vos

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  32. Paul J. Nederkoorn

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  33. Marianne A. A. van Walderveen

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  34. Julie Staals

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  35. Jeannette Hofmeijer

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  36. Jacques A. van Oostayen

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  37. Jelis Boiten

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  38. Patrick A. Brouwer

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  39. Bart J. Emmer

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  40. Sebastiaan F. de Bruijn

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  41. Lukas Carolus van Dijk

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  42. L. Jaap Kappelle

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  43. Rob H. Lo

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  44. Ewoud J. van Dijk

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  45. Joost de Vries

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  46. Paul L.M. de Kort

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  47. Willem Jan J. van Rooij

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  48. Jan S.P. van den Berg

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  49. Boudewijn A.A.M. van Hasselt

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  50. Leo A.M. Aerden

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  51. René J. Dallinga

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  52. Marieke C H de Visser

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  53. Joost Bot

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  54. Patrick C. A. J. Vroomen

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  55. Omid S. Eshghi

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  56. Tobien H.C.M.L. Schreuder

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  57. Roel J.J. Heijboer

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  58. Koos Keizer

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  59. Alexander V. Tielbeek

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  60. Heleen M. den Hertog

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  61. Dick G. Gerrits

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  62. Renske M. van den Berg‐Vos

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  63. Giorgos B. Karas

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  64. H. Zwenneke Flach

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  65. Henk A. Marquering

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  66. Marieke E.S. Sprengers

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  67. Sjoerd F.M. Jenniskens

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  68. Ludo F.M. Beenen

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  69. René van den Berg

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  70. Peter J. Koudstaal

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  71. Wim H. van Zwam

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  72. Yvo B.W.E.M. Roos

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  73. Robert J. van Oostenbrugge

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  74. Charles B.L.M. Majoie

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  75. Martin M. Brown

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  76. Thomas Liebig

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  77. Theo Stijnen

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  78. Tommy Andersson

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  79. Heinrich Paul Mattle

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  80. Nils Gunnar Wahlgren

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  81. Esther van der Heijden

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  82. Naziha el Ghannouti

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  83. Nadine Fleitour

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  84. Imke Hooijenga

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  85. Corina Puppels

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  86. Wilma Pellikaan

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  87. Annet Geerling

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  88. Annemieke Lindl-Velema

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  89. Gina van Vemde

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  90. Ans de Ridder

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  91. Paut Greebe

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  92. Tiny Simons

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

  93. Gert Messchendorp

    Health and Education Research Management and Epidemiologic Services (United States)

    Affiliation as printed

    for the HERMES CollaboratorsMR CLEAN Registry Investigators

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