Machine Learning Models Predict 90-Day Functional Outcome in Posterior Circulation Thrombectomy: Derivation and External Validation of the "FORECAST-PC" Prediction Scores
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 732
- 试验地点
- 1
- 主要终点
- Unfavorable Functional Outcome at 90 Days
研究概览
简要总结
This study aims to develop and externally validate machine learning prediction models (FORECAST-PC) to determine 90-day functional outcomes for patients suffering from acute ischemic stroke in the posterior circulation who are selected for endovascular thrombectomy (EVT)
详细描述
Outcome prediction after endovascular treatment (EVT) for posterior circulation (PC) acute ischemic stroke remains challenging, as current prognostic tools are often limited strictly to basilar artery occlusions or rely heavily on anterior circulation data. The FORECAST-PC study is an investigator-initiated, retrospective, international multicenter cohort study designed to develop and validate comprehensive PC outcome prediction models across key stages of the clinical pathway: Baseline, Pre-EVT, Immediately Post-EVT, and 24-hours Post-EVT. The models are derived from patients across three European centers and externally validated on an unseen cohort from 11 international centers to ensure robustness against geographic domain shifts and variations in clinical workflows. The clinical utility of these models is assessed using Decision Curve Analysis to demonstrate the net benefit of model-guided prognostication over standard clinical assumptions.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age > 18 years
- •Presentation with acute ischemic stroke (AIS) attributed to a radiologically confirmed posterior circulation occlusion
- •Selected for Endovascular Thrombectomy (EVT) according to the treating physician
- •Pre-stroke modified Rankin Scale (mRS) 0-3
- •EVT initiated or attempted within 24-hours of the last known well (LKW) time
- •Includes cases with/without prior intravenous thrombolysis (IVT), mothership, and drip-and-ship pathways
排除标准
- •EVT carried out beyond 24 hours from stroke onset
- •EVT performed secondarily after in-hospital worsening or stroke recurrence
- •In-hospital strokes (to avoid the confounding influence of prior systemic comorbidities and the acute event that necessitated initial admission)
- •Missing primary outcome data
- •Inconsistencies between descriptive dependence status and raw pre-stroke mRS
- •Stroke cases occurring prior to 2015 (to account for major changes in endovascular treatment techniques)
研究组 & 干预措施
Derivation cohort
Patients with PC stroke selected for EVT from three primary training centers (Lausanne University Hospital, Bern University Hospital, and Charité-Universitätsmedizin Berlin).
干预措施: FORECAST-PC Prediction Models (Other)
External Validation Cohort
Unseen patients with PC stroke selected for EVT from 11 independent, world-wide comprehensive stroke centers
干预措施: FORECAST-PC Prediction Models (Other)
结局指标
主要结局
Unfavorable Functional Outcome at 90 Days
时间窗: 90 days
Defined as a dichotomized 90-day modified Rankin Scale (mRS) score of 3 to 6 (where 0-2 is favorable and 3-6 is unfavorable).
次要结局
未报告次要终点
研究者
Dr. med. Alexander Salerno, MD-PhD
Dr. med., MD-PhD, MERc-PD
Centre Hospitalier Universitaire Vaudois