Will This Stroke Patient Benefit From Urgent Carotid Revascularization? A New, Highly Accurate Model Might Have the Answer
Researchers have developed a model that achieved 93% accuracy in predicting neurologic functional independence after carotid revascularization in patients with acute stroke. They described the achievement in a study in the Journal of the American College of Surgeons.
“By integrating a real-time frailty risk score into the electronic medical record, presenting stroke severity and other variables, we can proactively identify who will benefit from immediate surgery and who may need ‘pre-habilitating’ before surgery to achieve better outcomes,” said study senior author Hernan Bazan, MD, DFSVS, FACS, of Ochsner Health, New Orleans, Louisiana.
Researchers built several models using data for 302 patients who underwent urgent carotid endarterectomy (CEA) and carotid artery stenting (CAS) at a tertiary comprehensive stroke center between 2015 and 2023.
Among the patients, 72.8% were discharged with a Modified Rankin Scale score of 2 or less, meeting researchers’ criteria for neurological functional independence. The 30-day rate of stroke, death, and myocardial infarction in patients was 8.3%. The rate was 6.5% in patients who received CEA alone and 12.5% in patients who received CAS.
The best-performing model incorporated 4 critical clinical metrics: the severity of stroke per the National Institutes of Health Stroke Scale, frailty risk score, time to intervention, and thrombolysis use. According to the study, it correctly predicted 93% of functional independence outcomes in patients and achieved an area under the receiver operating characteristic curve of 0.808.
“This high predictive capability can enhance clinical decision-making and improve patient outcomes by identifying those most likely to benefit from timely carotid revascularization,” wrote Bazan and coauthors in the study.
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