4
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      External validation of clinical risk prediction score for elderly treated with endovascular thrombectomy

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background and aim

          The thrombectomy in the elderly prediction score (TERPS) for functional outcome after anterior circulation endovascular therapy (EVT) in patients ≥ 80 years was recently developed. The aim of this study was to assess predictors of functional outcome in the elderly and validate the prediction model.

          Methods

          Consecutive patients treated with EVT from the Oslo Acute Reperfusion Stroke Study were evaluated for inclusion. Clinical and radiological parameters were used to calculate the TERPS, and functional outcome were assessed at 3-month follow-up.

          Results

          Out of 1028 patients who underwent EVT for acute ischemic stroke from January 2017 to July 2022, 218 (21.2%) patients ≥ 80 years with anterior ischemic stroke were included. Fair outcome, defined as modified Rankin scale ≤ 3 (mRS), was achieved in 117 (53.7%). In bivariate analyses, male sex ( p 0.035), age ( p 0.025), baseline National Institute of Health Stroke Scale (NIHSS, p < 0.001), pre-stroke mRS ( p 0.002) and Alberta Stroke Program Early Computed Tomography score (ASPECTS, p 0.001) were associated with fair outcome. Significant predictors for fair outcome in regression analyses were lower pre-stroke mRS, adjusted odd ratio, (aOR) 0.67 (95% CI 0.50–0.91, p 0.01), NIHSS, aOR 0.92 (95% CI 0.87–0.97, p 0.002), and higher ASPECTS, aOR 1.22 (95% CI 1.03–1.44, p 0.023). The area under the curve (AUC) using TERPS was 0.74 (95% CI 0.67–0.80).

          Conclusions

          The risk prediction score TERPS showed moderate performance in this external validation. Other variables may still be included to improve the model and validation using other cohorts is recommended.

          Trial registration

          NCT06220981.

          Related collections

          Most cited references38

          • Record: found
          • Abstract: found
          • Article: not found

          Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials.

          In 2015, five randomised trials showed efficacy of endovascular thrombectomy over standard medical care in patients with acute ischaemic stroke caused by occlusion of arteries of the proximal anterior circulation. In this meta-analysis we, the trial investigators, aimed to pool individual patient data from these trials to address remaining questions about whether the therapy is efficacious across the diverse populations included.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            The Heidelberg Bleeding Classification: Classification of Bleeding Events After Ischemic Stroke and Reperfusion Therapy.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators.

              Thrombolysis for acute ischaemic stroke has been investigated in several clinical trials, with variable results. We have assessed the safety and efficacy of intravenous thrombolysis with alteplase (0.9 mg/kg bodyweight) within 6 h of stroke onset. This non-angiographic, randomised, double-blind, trial enrolled 800 patients in Europe, Australia, and New Zealand. Computed tomography was used to exclude patients with signs of major infarction. Alteplase (n=409) and placebo (n=391) were randomly assigned with stratification for time since symptom onset (0-3 h or 3-6 h). The primary endpoint was the modified Rankin scale (mRS) at 90 days, dichotomised for favourable (score 0-1) and unfavourable (score 2-6) outcome. Analyses were by intention to treat. 165 (40.3%) alteplase-group patients and 143 (36.6%) placebo-group patients had favourable mRS outcomes (absolute difference 3.7%, p=0.277). In a posthoc analysis of mRS scores dichotomised for death or dependency, 222 (54.3%) alteplase-group and 180 (46.0%) placebo-group patients had favourable outcomes (score 0-2; absolute difference 8.3%, p=0.024). Treatment differences were similar whether patients were treated within 3 h or 3-6 h. 85 (10.6%) patients died, with no difference between treatment groups at day 90+/-14 days (43 alteplase, 42 placebo). Symptomatic intracranial haemorrhage occurred in 36 (8.8%) alteplase-group patients and 13 (3.4%) placebo-group patients. The results do not confirm a statistical benefit for alteplase. However, we believe the trend towards efficacy should be interpreted in the light of evidence from previous trials. Despite the increased risk of intracranial haemorrhage, thrombolysis with alteplase at a dose of 0.9 mg/kg in selected patients may lead to a clinically relevant improvement in outcome.
                Bookmark

                Author and article information

                Contributors
                a.h.aamodt@medisin.uio.no
                Journal
                J Neurol
                J Neurol
                Journal of Neurology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-5354
                1432-1459
                2 July 2024
                2 July 2024
                2024
                : 271
                : 9
                : 5838-5845
                Affiliations
                [1 ]Department of Neurology, Oslo University Hospital, Rikshospitalet, ( https://ror.org/00j9c2840) Oslo, Norway
                [2 ]Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, ( https://ror.org/00j9c2840) Oslo, Norway
                [3 ]Department of Neurology, Stroke Center Rigshospitalet, ( https://ror.org/03mchdq19) Copenhagen, Denmark
                [4 ]Faculty of Health and Medical Sciences, The University of Copenhagen, ( https://ror.org/035b05819) Copenhagen, Denmark
                [5 ]Institute of Clinical Medicine, University of Oslo, ( https://ror.org/01xtthb56) Oslo, Norway
                [6 ]Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, ( https://ror.org/05xg72x27) Trondheim, Norway
                Author information
                http://orcid.org/0000-0002-6535-0445
                http://orcid.org/0000-0002-6746-1579
                http://orcid.org/0000-0002-0556-2331
                http://orcid.org/0000-0001-6648-7761
                http://orcid.org/0000-0003-1196-9709
                http://orcid.org/0000-0003-1779-3054
                http://orcid.org/0000-0001-9156-6357
                http://orcid.org/0000-0001-7950-4882
                http://orcid.org/0000-0002-2824-2760
                Article
                12535
                10.1007/s00415-024-12535-6
                11377628
                38954035
                c88df14c-579e-45e5-804b-0199bac1e2c4
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 13 February 2024
                : 29 May 2024
                : 23 June 2024
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100013263, Nasjonalforeningen for Folkehelsen;
                Award ID: 22662
                Award Recipient :
                Funded by: NTNU Norwegian University of Science and Technology (incl St. Olavs Hospital - Trondheim University Hospital)
                Categories
                Original Communication
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2024

                Neurology
                thrombectomy,elderly,ischemic stroke,prediction
                Neurology
                thrombectomy, elderly, ischemic stroke, prediction

                Comments

                Comment on this article