Background: The AHA/ASA guideline recommends endovascular therapy for patients with acute ischemic stroke within 6 hours from symptom onset. Identification of the patients most likely to benefit (and those most likely to be harmed) from reperfusion plays a pivotal role in decision-making. We applied the MR PREDICTS tool (clinical decision making tool derived from MR CLEAN clinical trial) on a real-world sample of patients with acute ischemic stroke to assess its utility in predicting clinical benefit from endovascular therapy.
Methods: We identified all patients with acute ischemic stroke with occlusion of the distal internal carotid artery, proximal M1, or M2 segment of the middle cerebral artery who underwent endovascular reperfusion procedure (thrombectomy and/or intra-arterial thrombolysis) from July 2016 to June 2017. Patients were divided into two groups; those with a good outcome (90 Day mRS 0-2) and those with a poor outcome (90 Day mRS 3-6). The MR PREDICTS tool was used to determine absolute treatment benefit for each patient. This predicted outcome was compared to actual patient outcome.
Results: A total of 22 patients were identified. Eight patients had a good outcome and 14 patients had a poor outcome. The calculated absolute treatment benefit from endovascular therapy using the MR PREDICTS tool was consistently higher among patients in the good outcome group, with an average absolute treatment benefit of 12% greater among these patients compared to those in the poor outcome cohort (19% versus 7%). Of note, patients with a poor outcome had a higher rate of prior stroke, higher baseline NIHSS, longer symptom onset to groin puncture time, less favorable collaterals and lower rate of successful recanalization defined as TICI 2b or 3 (100% versus 64%).
Conclusion: There is a strong correlation between predicted treatment benefit by MR PREDICTS tool and actual patient outcomes which supports broader use of this tool during the decision-making process for endovascular therapy in patients with acute ischemic stroke.