The Charlotte Large Artery Occlusion Endovascular Therapy Outcome Score Predicts Poor Outcomes 1 Year After Endovascular Thrombectomy

Karamchandani, Rahul R; Satyanarayana, Sagar; Yang, Hongmei; Rhoten, Jeremy B; Strong, Dale; Patel, Nikhil M; Clemente, Jonathan D.; Defilipp, Gary; Bernard, J; Stetler, William R.; Parish, Jonathan; Asimos, Andrew W

doi:10.1016/j.wneu.2023.02.066

Cited by 2 publications

(4 citation statements)

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“…Similar results were observed when considering all patients, irrespective of revascularization status. CLEOS incorporates patient age, presenting NIHSS, initial glucose, and CBV index from automated CTP software, and it has previously been reported to predict poor functional outcomes (90‐day and 1‐year mRS 4‐6) in anterior circulation thrombectomy patients 5,13 …”

Section: Discussionmentioning

confidence: 99%

“…CLEOS incorporates patient age, presenting NIHSS, initial glucose, and CBV index from automated CTP software, and it has previously been reported to predict poor functional outcomes (90-day and 1-year mRS 4-6) in anterior circulation thrombectomy patients. 5,13 Prior groups report clinical and imaging markers as prognosticators after an acute stroke, some of which are specific to the thrombectomy population. In patients treated with EVT, NIHSS ≤10 at 24 hours was associated with independent functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Early indicators of a good outcome can serve patients and families as they navigate the acute and post‐acute hospital course. An accurate prognosis may inform acute care decision‐making, hospital length of stay, post‐acute care disposition, and resource utilization, for families and the healthcare system 5,13 . Wouters et al reported that baseline National Institutes of Health Stroke Scale (NIHSS) score and change in NIHSS at 24 hours predict 90‐day modified Rankin Scale (mRS) 0‐2 in ischemic stroke patients, 14 while NIHSS ≤10 at 24 hours predicts good outcomes in patients undergoing EVT 15 .…”

Section: Introductionmentioning

confidence: 99%

“…An accurate prognosis may inform acute care decision-making, hospital length of stay, post-acute care disposition, and resource utilization, for families and the healthcare system. 5,13 Wouters et al reported that baseline National Institutes of Health Stroke Scale (NIHSS) score and change in NIHSS at 24 hours predict 90-day modified Rankin Scale (mRS) 0-2 in ischemic stroke patients, 14 while NIHSS ≤10 at 24 hours predicts good outcomes in patients undergoing EVT. 15 While NIHSS was a predictor of functional outcome in these studies, other retrospective data contrarily suggest that up to 30% of patients with minor strokes (presenting NIHSS ≤5) have disabling neurological deficits at 90-day follow-up.…”

Section: Introductionmentioning

confidence: 99%

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The Charlotte Large artery occlusion Endovascular therapy Outcome Score predicts independent outcome after thrombectomy

Karamchandani,

Satyanarayana,

Yang

et al. 2023

Journal of Neuroimaging

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Background and PurposePredicting functional outcomes after endovascular thrombectomy (EVT) is of interest to patients and families as they navigate hospital and post‐acute care decision‐making. We evaluated the prognostic ability of several scales to predict good neurological function after EVT.MethodsWe retrospectively analyzed records from a health system's code stroke registry, including consecutive successful thrombectomy patients from August 2020 to February 2023 presenting with an anterior circulation large vessel occlusion who were evaluated with pre‐EVT CT perfusion. Primary and secondary outcomes were 90‐day modified Rankin Scale (mRS) scores 0‐2 and 0‐1, respectively. Logistic regression was performed to evaluate the ability of each scale to predict the outcomes. Scales were compared by calculating the area under the curve (AUC).ResultsA total of 465 patients (mean age 68.1 [±14.9] years, median National Institutes of Health Stroke Scale [NIHSS] 16 [11‐21]) met inclusion criteria. In the logistic regression, the Charlotte Large artery occlusion Endovascular therapy Outcome Score (CLEOS), Totaled Health Risks in Vascular Events, Houston Intra‐Arterial Therapy‐2, Pittsburgh Response to Endovascular therapy, and Stroke Prognostication using Age and NIHSS were significant in predicting the primary and secondary outcomes. CLEOS was superior to all other scales in predicting 90‐day mRS 0‐2 (AUC .75, 95% confidence interval [CI] .70‐.80) and mRS 0‐1 (AUC .74, 95% CI .69‐.78). Twenty of 22 patients (90.9%) with CLEOS <315 had 90‐day mRS 0‐2.ConclusionsCLEOS predicts independent and excellent neurological function after anterior circulation EVT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Charlotte Large artery occlusion Endovascular therapy Outcome Score predicts independent outcome after thrombectomy

Karamchandani,

Satyanarayana,

Yang

et al. 2023

Journal of Neuroimaging

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Predicting severe disability or death in endovascular thrombectomy with large computed tomography perfusion core infarction and limited penumbra

et al. 2023

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Background Patients presenting with large core infarctions benefit from treatment with endovascular thrombectomy (EVT), with a notable 50% reduction in rates of severe disability (modified Rankin Scale [mRS] 5) at 90 days. We studied the ability of previously reported prognostic scales to predict devastating outcomes in patients with a large ischemic core and limited salvageable brain tissue. Methods Retrospective analysis from a health system's code stroke registry, including consecutive thrombectomy patients from November 2017 to December 2022 with an anterior circulation large vessel occlusion, computed tomography perfusion core infarct ≥ 50 ml, and mismatch volume < 15 ml or mismatch ratio < 1.8. Previously reported scales were compared using logistic regression and area under the curve (AUC) analyses to predict 90-day mRS 5-6. Results Sixty patients (mean age 62.38 ± 14.25 years, median core volume 103 ml [74.75–153]) met inclusion criteria, of whom 27 (45%) had 90-day mRS 5-6. The Charlotte Large artery occlusion endovascular therapy Outcome Score (CLEOS) (odds ratio [OR] 1.35, 95% CI [1.14–1.60], p = 0.0005), Houston Intra-Arterial Therapy-2 (OR 1.35, 95% CI [1.00–1.83], p = 0.0470), and Totaled Health Risks in Vascular Events (OR 1.53, 95% CI [1.07–2.18], p = 0.0199) predicted the primary outcome in the logistic regression analysis. CLEOS performed best in the AUC analysis (AUC 0.83, 95% CI [0.72–0.94]). Conclusion CLEOS predicts devastating outcomes after EVT in patients with large core infarctions and small volumes of ischemic penumbra.

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The Charlotte Large Artery Occlusion Endovascular Therapy Outcome Score Predicts Poor Outcomes 1 Year After Endovascular Thrombectomy

Cited by 2 publications

References 20 publications

The Charlotte Large artery occlusion Endovascular therapy Outcome Score predicts independent outcome after thrombectomy

The Charlotte Large artery occlusion Endovascular therapy Outcome Score predicts independent outcome after thrombectomy

Predicting severe disability or death in endovascular thrombectomy with large computed tomography perfusion core infarction and limited penumbra

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