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Peacock M, Drumm B, Klein P, Raymond J, Huo X, Chen Y, Abdalkader M, Schonewille WJ, Liu X, Hu W, Li C, Ji X, Alemseged F, Liu L, Siegler JE, Nagel S, Strbian D, Sacco S, Yaghi S, Qureshi MM, Fischer U, Aguiar de Sousa D, Yamagami H, Michel P, Puetz V, Mujanovic A, Marto JP, Kristoffersen ES, Sandset EC, Demeestere J, Hanning U, Novakovic R, Kenmuir C, Agid R, Romoli M, Diana F, Lobotesis K, Roi D, Masoud HE, Ma A, Zhu Y, Sang H, Sun D, Ton MD, Raynald, Li F, Nasreldein A, Jesser J, Kaesmacher J, Weyland CS, Meyer L, Yeo LLL, Yang Q, Thomalla G, Yang P, Poli S, Campbell BCV, Qureshi AI, Chen HS, Zaidat OO, Qiu Z, Nogueira RG, Jovin TG, Miao Z, Nguyen TN, Banerjee S. Basilar artery occlusion management: An international survey of gender influence on management. Interv Neuroradiol 2024:15910199241265590. [PMID: 39140366 DOI: 10.1177/15910199241265590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The superiority of endovascular thrombectomy (EVT) over medical management was not established in two early basilar artery occlusion (BAO) randomized controlled trials. Despite this, many clinicians recommended EVT for acute BAO under certain circumstances. This paper aims to compare physicians' diagnostic and management strategies of BAO according to gender. METHODS From January to March 2022 an international survey was conducted regarding management strategies in acute BAO. We compared responses between clinicians by identifying gender. Questions were designed to examine clinical and imaging parameters influencing management of patients with BAO. RESULTS Among the 1245 respondents from 73 countries, 311 (25.0%) identified as female. This figure was 13.6% amongst interventionists. Geographically, female respondents were lowest in Asia (14.5%) and North America (23.9%). The proportion of respondents identifying as female was consistent regardless of their years of experience. Female respondents were more likely to choose time of onset as time of first estimated stroke like symptom (48.0% vs. 38.5%, p < .01), were less likely to favor thrombectomy in the V4 segment of vertebrobasilar artery occlusions (31.5% vs. 43.3%, p < .01), and were less likely to find it acceptable to enroll all patients who met trial criteria in the standard medical treatment arm of a clinical trial (41.2% vs. 47.0%, p = .01). Male respondents were more likely to agree that thrombolysis would not alter their decision on proceeding with EVT (93.7% vs. 88.3%, p < .01). CONCLUSIONS Female clinicians appear to be significantly underrepresented in stroke medicine. This is most pronounced amongst interventionists and in Asia. Although male and female opinions were closely aligned on many aspects of BAO management, differences in opinion were observed in a number of significant areas which influence decision making.
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Affiliation(s)
- Meabh Peacock
- Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Brian Drumm
- Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Department of Stroke Medicine, Chelsea and Westminster NHS Trust, London, UK
| | - Piers Klein
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jean Raymond
- Department of Radiology, Interventional Neuroradiology Division, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Xiaochuan Huo
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Xinfeng Liu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei Hu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | | | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Fana Alemseged
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Liping Liu
- Neurology, Beijing Tiantan Hospital, Beijing, China
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Muhammad M Qureshi
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Diana Aguiar de Sousa
- Stroke Center, Lisbon Central University Hospital and Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan
| | - Patrik Michel
- Stroke Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway and Department of General Practice, University of Oslo, Oslo, Norway
| | - Else C Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance, Oslo, Norway
| | - Jelle Demeestere
- Neurology Department, Leuven University Hospital, Leuven, Belgium
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Novakovic
- Department of Neurology and Radiology, UT Southwestern, Dallas, TX, USA
| | | | - Ronit Agid
- Division of Interventional Neuroradiology, Toronto Western Hospital, JDMI, UHN, University of Toronto, Toronto, Canada
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Francesco Diana
- Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Kyriakos Lobotesis
- Interventional Neuroradiology Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Dylan Roi
- Interventional Neuroradiology Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Hesham E Masoud
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alice Ma
- Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Yuyou Zhu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hongfei Sang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dapeng Sun
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Mai Duy Ton
- Stroke Center, Bach Mai Hospital, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Stroke and Cerebrovascular Disease, VNU-University of Medicine and Pharmacy, Hanoi, Vietnam
| | - Raynald
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Ahmed Nasreldein
- Neurology, Assiut University Hospitals, Assiut University, Assiut, Egypt
| | - Jessica Jesser
- Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | | | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Sven Poli
- Department of Neurology, University of Tuebingen, Tübingen, Germany
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Osama O Zaidat
- Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, USA
| | - Zhongming Qiu
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tudor G Jovin
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Zhongrong Miao
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Soma Banerjee
- Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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Sun D, Yang X, Huo X, - R, Jia B, Tong X, Wang A, Ma N, Gao F, Mo D, Miao Z. Incidence and predictors of futile recanalisation after endovascular therapy in acute vertebrobasilar artery occlusion patients: insight from the ANGEL-ACT registry. Stroke Vasc Neurol 2024; 9:289-294. [PMID: 37827853 PMCID: PMC11221304 DOI: 10.1136/svn-2022-002185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 09/15/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES To identify the occurrence rate and predictors of futile recanalisation after endovascular therapy (EVT) for acute vertebrobasilar artery occlusion (VBAO). METHODS Participants of the Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischaemic Stroke (ANGEL-ACT) registry were selected for the analysis. Futile recanalisation was defined as patients did not achieve a 90-day good outcome (modified Rankin Scale ≤3) despite successful recanalisation (modified Treatment in Cerebral Ischaemia Scale ≥2b) after the procedure. Multivariable logistic regression analysis was conducted to find independent predictors of futile recanalisation in VBAO patients undergoing EVT. RESULTS Three hundred and fifteen patients with VBAO who achieved successful recanalisation after EVT were included in current analysis, of whom, 155 (49.2%) suffered futile recanalisation, and 160 achieved effective recanalisation. After the multivariable analysis, we found admission National Institutes of Health Stroke Scale (NIHSS) ≥19 (OR 4.81, 95% CI 2.76 to 8.39, p<0.001), platelet-lymphocyte ratio (PLR) ≥162.2 (OR 1.93, 95% CI 1.14 to 3.27, p=0.001), onset-to-puncture time (OTP) ≥334 min (OR 2.15, 95% CI 1.25 to 3.68, p=0.005) and use of general anesthesia (GA) (OR 1.87, 95% CI 1.09 to 3.22, p=0.024) were associated with futile recanalisation. CONCLUSIONS Futile recanalisation after EVT occurred 49.2% of VBAO patients in the ANGEL-ACT registry. NIHSS≥19, PLR≥162.2, OTP≥334 min and use of GA were independent predictors of futile recanalisation.
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Affiliation(s)
- Dapeng Sun
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
| | - Xinguang Yang
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
| | - Xiaochuan Huo
- Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Raynald -
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
| | - Baixue Jia
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
| | - Xu Tong
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
| | - Feng Gao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
| | - Dapeng Mo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
| | - Zhongrong Miao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
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Zhang X, Miao J, Yang J, Liu C, Huang J, Song J, Xie D, Yue C, Kong W, Hu J, Luo W, Liu S, Li F, Zi W. DWI-Based Radiomics Predicts the Functional Outcome of Endovascular Treatment in Acute Basilar Artery Occlusion. AJNR Am J Neuroradiol 2023; 44:536-542. [PMID: 37080720 PMCID: PMC10171394 DOI: 10.3174/ajnr.a7851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/15/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment is a reference treatment for acute basilar artery occlusion (ABAO). However, no established and specific methods are available for the preoperative screening of patients with ABAO suitable for endovascular treatment. This study explores the potential value of DWI-based radiomics in predicting the functional outcomes of endovascular treatment in ABAO. MATERIALS AND METHODS Patients with ABAO treated with endovascular treatment from the BASILAR registry (91 patients in the training cohort) and the hospitals in the Northwest of China (31 patients for the external testing cohort) were included in this study. The Mann-Whitney U test, random forests algorithm, and least absolute shrinkage and selection operator were used to reduce the feature dimension. A machine learning model was developed on the basis of the training cohort to predict the prognosis of endovascular treatment. The performance of the model was evaluated on the independent external testing cohort. RESULTS A subset of radiomics features (n = 6) was used to predict the functional outcomes in patients with ABAO. The areas under the receiver operating characteristic curve of the radiomics model were 0.870 and 0.781 in the training cohort and testing cohort, respectively. The accuracy of the radiomics model was 77.4%, with a sensitivity of 78.9%, specificity of 75%, positive predictive value of 83.3%, and negative predictive value of 69.2% in the testing cohort. CONCLUSIONS DWI-based radiomics can predict the prognosis of endovascular treatment in patients with ABAO, hence allowing a potentially better selection of patients who are most likely to benefit from this treatment.
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Affiliation(s)
- X Zhang
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Neurology (X.Z.), The Affiliated Hospital of Northwest University Xi'an No.3 Hospital, Xian, China
| | - J Miao
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Neurology (J.M.), Xianyang Hospital of Yan'an University, Xianyang, China
| | - J Yang
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - C Liu
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - J Huang
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - J Song
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - D Xie
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - C Yue
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - W Kong
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - J Hu
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - W Luo
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - S Liu
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - F Li
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - W Zi
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Karamchandani RR, Satyanarayana S, Yang H, Rhoten JB, Strong D, Singh S, Clemente JD, Defilipp G, Hazim M, Patel NM, Bernard J, Stetler WR, Parish JM, Blackwell TA, Heit JJ, Albers GW, Saba K, Guzik AK, Wolfe SQ, Asimos AW. The Charlotte Large Artery Occlusion Endovascular Therapy Outcome Score Compares Favorably to the Critical Area Perfusion Score for Prognostication Before Basilar Thrombectomy. J Stroke Cerebrovasc Dis 2023; 32:107147. [PMID: 37119791 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION The Critical Area Perfusion Score (CAPS) predicts functional outcomes in vertebrobasilar thrombectomy patients based on computed tomography perfusion (CTP) hypoperfusion. We compared CAPS to the clinical-radiographic Charlotte Large artery occlusion Endovascular therapy Outcome Score (CLEOS). METHODS Acute basilar thrombosis patients from January 2017-December 2021 were included in this retrospective analysis from a health system's stroke registry. Inter-rater reliability was assessed for 6 CAPS raters. A logistic regression with CAPS and CLEOS as predictors was performed to predict 90-day modified Rankin Scale (mRS) score 4-6. Area under the curve (AUC) analyses were performed to evaluate prognostic ability. RESULTS 55 patients, mean age 65.8 (± 13.1) years and median NIHSS score 15.55-24, were included. Light's kappa among 6 raters for favorable versus unfavorable CAPS was 0.633 (95% CI 0.497-0.785). Increased CLEOS was associated with elevated odds of a poor outcome (odds ratio (OR) 1.0010, 95% CI 1.0007-1.0014, p<0.01), though CAPS was not (OR 1.0028, 95% CI 0.9420-1.0676, p=0.93). An overall favorable trend was observed for CLEOS (AUC 0.69, 95% CI 0.54-0.84) versus CAPS (AUC 0.49, 95% CI 0.34-0.64; p=0.051). Among 85.5% of patients with endovascular reperfusion, CLEOS had a statistically higher sensitivity than CAPS at identifying poor 90-day outcomes (71% versus 21%, p=0.003). CONCLUSIONS CLEOS demonstrated better predictive ability than CAPS for poor outcomes overall and in patients achieving reperfusion after basilar thrombectomy.
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Affiliation(s)
- Rahul R Karamchandani
- Department of Neurology, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States.
| | - Sagar Satyanarayana
- Information and Analytics Services, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Hongmei Yang
- Information and Analytics Services, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Jeremy B Rhoten
- Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Dale Strong
- Information and Analytics Services, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Sam Singh
- Information and Analytics Services, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Jonathan D Clemente
- Charlotte Radiology, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Gary Defilipp
- Charlotte Radiology, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Manuel Hazim
- Wake Forest University School of Medicine, 475 Vine Street, Winston-Salem, NC 27101
| | - Nikhil M Patel
- Department of Internal Medicine, Pulmonary and Critical Care, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Joe Bernard
- Carolina Neurosurgery and Spine Associates, Neurosciences Institute, Atrium Health, 225 Baldwin Avenue, Charlotte, NC 28204, United States
| | - William R Stetler
- Carolina Neurosurgery and Spine Associates, Neurosciences Institute, Atrium Health, 225 Baldwin Avenue, Charlotte, NC 28204, United States
| | - Jonathan M Parish
- Carolina Neurosurgery and Spine Associates, Neurosciences Institute, Atrium Health, 225 Baldwin Avenue, Charlotte, NC 28204, United States
| | - Thomas A Blackwell
- Department of Emergency Medicine, Neurosciences Institute, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Jeremy J Heit
- Departments of Radiology and Neurosurgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 300 Pasteur Drive F3, Stanford, CA 94305, United States
| | - Kasser Saba
- Department of Neurology, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
| | - Amy K Guzik
- Department of Neurology, Wake Forest University School of Medicine, 1 Medical Center Boulevard, 4th floor, Winston-Salem, NC 27157, United States
| | - Stacey Q Wolfe
- Department of Neurological Surgery, Wake Forest University School of Medicine, 1 Medical Center Boulevard, 4th floor, Winston-Salem, NC 27157, United States
| | - Andrew W Asimos
- Department of Emergency Medicine, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States
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