Abstract
Background: Endovascular treatment (EVT) is effective for stroke patients with a large vessel occlusion (LVO) of the anterior circulation. To further improve personalized stroke care, it is essential to accurately predict outcome after EVT. Machine learning might outperform classical prediction methods as it is capable of addressing complex interactions and non-linear relations between variables.Methods: We included patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry, an observational cohort of LVO patients treated with EVT. We applied the following machine learning algorithms: Random Forests, Support Vector Machine, Neural Network, and Super Learner and compared their predictive value with classic logistic regression models using various variable selection methodologies. Outcome variables were good reperfusion (post-mTICI ≥ 2b) and functional independence (modified Rankin Scale ≤2) at 3 months using (1) only baseline variables and (2) baseline and treatment variables. Area under the ROC-curves (AUC) and difference of mean AUC between the models were assessed.Results: We included 1,383 EVT patients, with good reperfusion in 531 (38%) and functional independence in 525 (38%) patients. Machine learning and logistic regression models all performed poorly in predicting good reperfusion (range mean AUC: 0.53–0.57), and moderately in predicting 3-months functional independence (range mean AUC: 0.77–0.79) using only baseline variables. All models performed well in predicting 3-months functional independence using both baseline and treatment variables (range mean AUC: 0.88–0.91) with a negligible difference of mean AUC (0.01; 95%CI: 0.00–0.01) between best performing machine learning algorithm (Random Forests) and best performing logistic regression model (based on prior knowledge).Conclusion: In patients with LVO machine learning algorithms did not outperform logistic regression models in predicting reperfusion and 3-months functional independence after endovascular treatment. For all models at time of admission radiological outcome was more difficult to predict than clinical outcome.
Highlights
Endovascular treatment (EVT) is effective for ischemic stroke patients with a large vessel occlusion (LVO) of the anterior circulation
In the current analysis we included those patients who adhered to the following criteria: age 18 years and older, treatment in a center that participated in the MR CLEAN trial, and LVO in the anterior circulation (internal carotid artery (ICA), internal carotid artery terminus (ICA-T), middle (M1/M2) cerebral artery, or anterior (A1/A2) cerebral artery), shown by CT angiography (CTA) or digital subtraction angiography (DSA) [11]
We assessed the following clinical characteristics at admission: National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale, medical history (TIA, ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage, myocardial infarction, peripheral artery disease, diabetes mellitus, hypertension, hypercholesterolemia), smoking, laboratory tests, blood pressure, medication, modified Rankin Score before stroke onset, administration of intravenous tPA, stroke onset to groin time, transfer from another hospital, and whether the patient was admitted during weekend or off hours
Summary
Endovascular treatment (EVT) is effective for ischemic stroke patients with a large vessel occlusion (LVO) of the anterior circulation. A recent meta-analysis showed a positive treatment effect of EVT across patient subgroups including different age groups, varying stroke severity, sex, and stroke localization [1]. Many clinical and imaging predictors or their combinations were not considered in the subgroup analysis. The RCTs that provided the data differed in their patient selection criteria. To further improve personalized stroke care, it is essential to accurately predict outcome and eventually differentiate between patients who will and will not benefit from EVT. Endovascular treatment (EVT) is effective for stroke patients with a large vessel occlusion (LVO) of the anterior circulation. To further improve personalized stroke care, it is essential to accurately predict outcome after EVT. Machine learning might outperform classical prediction methods as it is capable of addressing complex interactions and non-linear relations between variables
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
