Revalidation of the RACE scale after its regional implementation in Catalonia: a triage tool for large vessel occlusion

Background and purposeOur aim was to revalidate the RACE scale, a prehospital tool that aims to identify patients with large vessel occlusion (LVO), after its region-wide implementation in Catalonia, and to analyze geographical differences in access to endovascular treatment (EVT).MethodsWe used data from the prospective CICAT registry (Stroke Code Catalan registry) that includes all stroke code activations. The RACE score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered. Sensitivity, specificity, and area under the curve (AUC) for the RACE cut-off value ≥5 for identification of both LVO and eligibility for EVT were calculated. We compared the rate of EVT and time to EVT of patients transferred from referral centers compared with those directly presenting to comprehensive stroke centers (CSC).ResultsThe RACE scale was evaluated in the field in 1822 patients, showing a strong correlation with the subsequent in-hospital evaluation of the National Institute of Health Stroke Scale evaluated at hospital (r=0.74, P<0.001). A RACE score ≥5 detected LVO with a sensitivity 0.84 and specificity 0.60 (AUC 0.77). Patients with RACE ≥5 harbored a LVO and received EVT more frequently than RACE <5 patients (LVO 35% vs 6%; EVT 20% vs 6%; all P<0.001). Direct admission at a CSC was independently associated with higher odds of receiving EVT compared with admission at a referral center (OR 2.40; 95% CI 1.66 to 3.46), and symtoms onset to groin puncture was 133 min shorter.ConclusionsThis large validation study confirms RACE accuracy to identify stroke patients eligible for EVT, and provides evidence of geographical imbalances in the access to EVT to the detriment of patients located in remote areas.

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Clot imaging characteristics predict first pass effect of aspiration—first approach to thrombectomy

Interventional Neuroradiology ◽

10.1177/15910199211019174 ◽

2021 ◽

pp. 159101992110191

Author(s):

Muhammad Waqas ◽

Weizhe Li ◽

Tatsat R Patel ◽

Felix Chin ◽

Vincent M Tutino ◽

...

Keyword(s):

Internal Carotid ◽

Validation Cohort ◽

Area Under The Curve ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

First Pass Effect ◽

Imaging Characteristics ◽

First Pass ◽

Sensitivity Specificity ◽

Youden’S Index

Background The value of clot imaging in patients with emergent large vessel occlusion (ELVO) treated with thrombectomy is unknown. Methods We performed retrospective analysis of clot imaging (clot density, perviousness, length, diameter, distance to the internal carotid artery (ICA) terminus and angle of interaction (AOI) between clot and the aspiration catheter) of consecutive cases of middle cerebral artery (MCA) occlusion and its association with first pass effect (FPE, TICI 2c-3 after a first attempt). Results Patients ( n = 90 total) with FPE had shorter clot length (9.9 ± 4.5 mm vs. 11.7 ± 4.6 mm, P = 0.07), shorter distance from ICA terminus (11.0 ± 7.1 mm vs. 14.7 ± 9.8 mm, P = 0.048), higher perviousness (39.39 ± 29.5 vs 25.43 ± 17.6, P = 0.006) and larger AOI (153.6 ± 17.6 vs 140.3 ± 23.5, P = 0.004) compared to no-FPE patients. In multivariate analysis, distance from ICA terminus to clot ≤13.5 mm (odds ratio (OR) 11.05, 95% confidence interval (CI) 2.65–46.15, P = 0.001), clot length ≤9.9 mm (OR 7.34; 95% CI 1.8–29.96, P = 0.005), perviousness ≥ 19.9 (OR 2.54, 95% CI 0.84–7.6, P = 0.09) and AOI ≥ 137°^ (OR 6.8, 95% CI 1.55–29.8, P = 0.011) were independent predictors of FPE. The optimal cut off derived using Youden’s index was 6.5. The area under the curve of a score predictive of FPE success was 0.816 (0.728–0.904, P < 0.001). In a validation cohort ( n = 30), sensitivity, specificity, positive and negative predictive value of a score of 6–10 were 72.7%, 73.6%, 61.5% and 82.3%. Conclusions Clot imaging predicts the likelihood of achieving FPE in patients with MCA ELVO treated with the aspiration-first approach.

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Abstract TMP35: Clinical Stroke Scales in Predicting Large Vessel Occlusion: A Metaanalysis

Stroke ◽

10.1161/str.48.suppl_1.tmp35 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

W Y kong ◽

Andrew Choong ◽

Nicholas Syn ◽

Vijay K Sharma ◽

Hock L Teoh ◽

...

Keyword(s):

Reference Lists ◽

Data Extraction ◽

Meta Analysis ◽

Arterial Occlusion ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Computed Tomography Angiogram ◽

Sensitivity Specificity ◽

Stroke Centre

Background: Identifying large vessel occlusion (LVO) is paramount in the era of endovascular therapy. This can be achieved easily by computed tomography angiogram(CTA) and magnetic resonance angiography(MRA). National Institute Health Stroke Scale(NIHSS) threshold can be used in primary stroke centre(PSC) without these facilities, to identify patients with LVO for transfer to a comprehensive stroke centre (CSC) for mechanical thrombectomy. Alternatively, simplified clinical stroke scales (CSS)can also be used by emergency medical services (EMS) to identify such patients to be directly transported to CSC. We aim to compare various CSS in predicting LVO in ischemic stroke. Methods: We searched PUBMED from January 2005 to July 2016 and screened reference lists of included studies, and included all diagnostic accuracy studies that investigate CSS and prediction of LVO confirmed with CTA or MRA. Two authors independently screened titles and abstracts and perform data extraction for analysis. Pooled sensitivity, specificity and diagnostic odd ratio (DOR) of various CSS were obtained using the random effects model. Result: 8 studies (total 8556 patients) were included for meta-analysis of 3 CSS. This includes the NIHSS≥5, ≥6, ≥10, ≥13; Cincinnati Prehospital Stroke Scale (CPSS)≥2 and Rapid Arterial oCclusion Evaluation (RACE) ≥ 5. Pooled sensivity and specificty for the respective cut off values of these CSS was metaanalysed and presented in table 1. NIHSS≥13 has the highest DOR (26.0), followed by NIHSS≥5 (16.9); whereas other NIHSS thresholds, CPSS and RACE were less predictive. NIHSS≥5 was found to have the highest sensitivity of 0.865 and NIHSS≥13 had the highest specificity of 0.934. Conclusion: We found 2 NIHSS thresholds that were most useful for identifying LVO. Depending on resources and preferences of each stroke centre, different NIHSS threshold can be utilized for purpose of ruling in LVO using a high NIHSS threshold, or ruling out LVO using a low NIHSS threshold.

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Abstract TP237: Can We Improve Clinical Detection of Right Hemisphere Large Vessel Occlusion?

Stroke ◽

10.1161/str.51.suppl_1.tp237 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sana Somani ◽

Melissa Gazi ◽

Michael Minor ◽

Joe Acker ◽

Abimbola Fadairo ◽

...

Keyword(s):

Left Hemisphere ◽

Right Hemisphere ◽

Trauma System ◽

Area Under The Curve ◽

Large Vessel ◽

Stroke Severity ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Emergency Medical ◽

The Right

Introduction: The Emergency Medical Stroke Assessment (EMSA) is a six point stroke severity scale with one point each for gaze preference, facial droop, arm drift, leg drift, abnormal naming, and abnormal repetition that was developed to help emergency medical services (EMS) providers identify acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). We hypothesized that the EMSA would detect left hemisphere LVO with a higher sensitivity than right hemisphere LVO. Methods: We trained 24 trauma system-based emergency communication center (ECC) paramedics in the EMSA. ECC-guided EMS in performance of the EMSA on patients with suspected stroke. We compared the sensitivity, specificity, area under the curve (AUC), and 95% confidence interval (CI) of ECC-guided prehospital EMSA for right versus left hemisphere ICA or M1 occlusion. Results: We enrolled 569 patients from September 2016 through February 2018, out of which 236 had a discharge diagnosis of stroke and 173 had a diagnosis of AIS. We excluded patients with bilateral (n=21) and brainstem (n=21) AIS. There were 64 patients with left hemisphere AIS including 19 with LVO. There were 67 patients with right hemisphere AIS including 22 with LVO. A score of ≥ 4 points yielded a sensitivity of 84.2 (95% CI = 60.4-96.6) and specificity of 66.7 (51.1-80.0) for left hemisphere LVO compared to a sensitivity of 68.2 (45.1-86.1) and specificity of 73.9 (58.9-85.7) for right hemisphere LVO. For predicting a left hemisphere LVO, the AUC was 0.77 (0.65-0.90) compared to 0.66 (0.50-0.82) for right-sided LVO. Assigning 2 points for abnormal gaze yielded an AUC of 0.78 (0.66-0.91) versus 0.67 (0.52-0.83) for left and right hemisphere LVO, respectively. Conclusions: The EMSA, like the National Institutes of Health Stroke Scale (NIHSS) upon which it is based, is more sensitive to left compared to right hemisphere LVO. More heavily weighting abnormal gaze did not improve the sensitivity of the EMSA for right hemisphere LVO. There is no comparable data on the right versus left hemisphere performance of other prehospital scales. There is a need to develop sensitive tests of right hemisphere dysfunction that are suitable for use in the field.

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Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion

10.21203/rs.2.9582/v2 ◽

2019 ◽

Author(s):

Tianli Zhang ◽

Xiaolong Wang ◽

Chao Wen ◽

Feng Zhou ◽

Shengwei Gao ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Area Under The Curve ◽

Functional Independence ◽

Large Vessel ◽

Multivariable Logistic Regression Analysis ◽

Large Vessel Occlusion ◽

Short Term ◽

Vessel Occlusion ◽

Blood Pressures

Abstract Background: Endovascular treatment (EVT) is advocated for acute ischemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging.This study investigated the relationship between post-EVT short-term blood pressure variability (BPV) and early outcomes in LVO patients. Methods: We retrospectively reviewed 72 LVO patients undergoing EVT between June 2015 and June 2018. Hourly systolic and diastolic blood pressures (SBP and DBP, respectively) were recorded in the first 24 hours post-EVT. BPV were evaluated as standard deviation (SD), coefficient of variation (CV), and successive variation (SV) separately for SBP and DBP. Three-month functional independence was defined as a modified Rankin Scale (mRS) score of 0-2. Results: For 58.3% patients with favorable outcomes, median National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores on admission were 14 and 8, respectively. The maximum SBP ([154.3±16.8] vs. [163.5±15.6], P=0.02), systolic CV ([8. 8%±2.0%] vs. [11.0%±1.8%], P<0.001), SV ([11.4±2.3] vs. [14.6±2.0], P<0.001), and SD ([10.5±2.4] vs. [13.8±3.9], P<0.001) were lower in patients with favorable outcomes. On multivariable logistic regression analysis, systolic SV (OR: 4.273, 95% CI: 1.030 to 17.727, P=0.045) independently predicted unfavorable prognosis. The area under the curve was 0.868 (95% CI: 0.781 to 0.955, P<0.001), and sensitivity and specificity were 93.3% and 73.8%, respectively, showing excellent value for 3-month poor-outcome predictions. Conclusions: Decreased systolic SV following intra-arterial therapies result in favorable 3-month outcomes. Systolic SV may be a novel predictor of functional prognosis in LVO patients.

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Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion

BMC Neurology ◽

10.1186/s12883-019-1457-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Tianli Zhang ◽

Xiaolong Wang ◽

Chao Wen ◽

Feng Zhou ◽

Shengwei Gao ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Area Under The Curve ◽

Functional Independence ◽

Large Vessel ◽

Multivariable Logistic Regression Analysis ◽

Large Vessel Occlusion ◽

Short Term ◽

Vessel Occlusion ◽

Poor Outcomes

Abstract Background Endovascular treatment (EVT) is advocated for acute ischaemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging. This study investigated the relationship between post-EVT short-term blood pressure variability (BPV) and early outcomes in LVO patients. Methods We retrospectively reviewed 72 LVO patients undergoing EVT between June 2015 and June 2018. Hourly systolic and diastolic blood pressures (SBP and DBP, respectively) were recorded in the first 24 h post-EVT. BPV were evaluated as standard deviation (SD), coefficient of variation (CV), and successive variation (SV) separately for SBP and DBP. Functional independence at 3 months was defined as a modified Rankin Scale (mRS) score of 0–2. Results For 58.3% patients with favorable outcomes, the median National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores on admission were 14 and 8, respectively. The maximum SBP ([154.3 ± 16.8] vs. [163.5 ± 15.6], P = 0.02), systolic CV ([8. 8% ± 2.0%] vs. [11.0% ± 1.8], P < 0.001), SV ([11.4 ± 2.3] vs. [14.6 ± 2.0], P < 0.001), and SD ([10.5 ± 2.4] vs. [13.8 ± 3.9], P < 0.001) were lower in patients with favorable outcomes. On multivariable logistic regression analysis, systolic SV (OR: 4.273, 95% CI: 1.030 to 17.727, P = 0.045) independently predicted unfavorable prognosis. The area under the curve was 0.868 (95% CI: 0.781 to 0.955, P < 0.001), and sensitivity and specificity were 93.3% and 73.8%, respectively, showing excellent predictive value for 3-month poor-outcomes. Conclusions Decreased systolic SV following intra-arterial therapies result in favorable outcomes at 3 months. Systolic SV may be a novel predictor of functional prognosis in LVO patients.

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Abstract 18: External Validation of the RACE Scale After Its Implementation in the Stroke Code Protocol in Catalonia

Stroke ◽

10.1161/str.48.suppl_1.18 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Natalia Perez de la Ossa ◽

Sonia Abilleira ◽

Marc Ribó ◽

Millan Monica ◽

Pere Cardona ◽

...

Keyword(s):

Validation Study ◽

External Validation ◽

Area Under The Curve ◽

Final Diagnosis ◽

Youden Index ◽

Vessel Occlusion ◽

Basilar Occlusion ◽

Race 2 ◽

Ischemic Attack ◽

Sensitivity Specificity

Introduction: We aimed to revalidate the RACE scale as a pre-hospital tool to identify patients with large vessel occlusion (LVO) and patients receiving endovascular treatment (EVT) after its implementation in the Stroke Code protocol of Catalonia (7.5 M inhabitants). Methods: We used data from the CICAT registry (Feb to Jun 2016), a government-mandated, prospective, hospital-based dataset that includes all Stroke Code activations. CICAT is linked to the EMS database to capture information about the pre-hospital care. RACE score, pre-hospital and in-hospital delays, final diagnostic, presence of LVO (TICA, MCA M1 or M2, tandem or basilar occlusion) and revascularization treatment were registered. Sensitivity, specificity and area under the curve (AUC) to identify LVO and patients receiving EVT were calculated for the pre-established cut off RACE≥5. Results: From the 1600 stroke code activations we included in the study the 962 patients in which the RACE scale was available (60%). The RACE scale showed a strong correlation with the NIHSS evaluated at hospital arrival (r=0.74, p<0.001). Distribution of final diagnosis and median RACE scores were: ischemic with LVO (22.1%), RACE 7 [5-8], ischemic without LVO (29.3%), RACE 3 [2-5], hemorrhagic(17.8%), RACE 6 [4-7], mimic(21.0%), RACE 2 [1-4] and transient ischemic attack(9.7%), RACE 3 [1-5]. A RACE cut-off score ≥5 showed sensitivity 0.80 and specificity 0.63 to detect LVO (AUC 0.78, Youden index 0.45), similar to results obtained in the validation study. In patients with RACE≥5 the rates of LVO (42% Vs 9%;p<0.001) and EVT (21% Vs 6%;p<0.001) were significantly higher than in patients with RACE<5. Conclusion: This large validation study performed after implementation of the RACE scale in the real clinical practice in the region of Catalonia confirms RACE accuracy to identify candidates to EVT. A RACE score ≥5 detected 77% of patients that finally underwent EVT confirming the scale as a valuable tool at the prehospital level.

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Capability of stroke scales to detect large vessel occlusion in acute ischemic stroke : A pilot study

Ideggyógyászati Szemle ◽

10.18071/isz.74.0099 ◽

2021 ◽

Vol 74 (3-4) ◽

pp. 99-103

Author(s):

Gábor Tárkányi ◽

Zsófia Nozomi Karádi ◽

Péter Csécsei ◽

Edit Bosnyák ◽

Gergely Fehér ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Area Under The Curve ◽

Arterial Occlusion ◽

Large Vessel ◽

Screening Methods ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Cross Sectional ◽

Stroke Centre

Rapid changes of stroke management in recent years facilitate the need for accurate and easy-to-use screening methods for early detection of large vessel occlusion (LVO) in acute ischemic stroke (AIS). Our aim was to evaluate the ability of various stroke scales to discriminate an LVO in AIS. We have performed a cross-sectional, observational study based on a registry of consecutive patients with first ever AIS admitted up to 4.5 hours after symptom onset to a comprehensive stroke centre. The diagnostic capability of 14 stroke scales were investigated using receiver operating characteristic (ROC) analysis. Area under the curve (AUC) values of NIHSS, modified NIHSS, shortened NIHSS-EMS, sNIHSS-8, sNIHSS-5 and Rapid Arterial Occlusion Evaluation (RACE) scales were among the highest (>0.800 respectively). A total of 6 scales had cut-off values providing at least 80% specificity and 50% sensitivity, and 5 scales had cut-off values with at least 70% specificity and 75% sensitivity. Certain stroke scales may be suitable for discriminating an LVO in AIS. The NIHSS and modified NIHSS are primarily suitable for use in hospital settings. However, sNIHSS-EMS, sNIHSS-8, sNIHSS-5, RACE and 3-Item Stroke Scale (3I-SS) are easier to perform and interpret, hence their use may be more advantageous in the prehospital setting. Prospective (prehospital) validation of these scales could be the scope of future studies.

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Electroencephalography Might Improve Diagnosis of Acute Stroke and Large Vessel Occlusion

Stroke ◽

10.1161/strokeaha.120.030150 ◽

2020 ◽

Vol 51 (11) ◽

pp. 3361-3365 ◽

Cited By ~ 1

Author(s):

Fareshte Erani ◽

Nadezhda Zolotova ◽

Benjamin Vanderschelden ◽

Nima Khoshab ◽

Hagop Sarian ◽

...

Keyword(s):

Neural Network ◽

Emergency Department ◽

Deep Learning ◽

Acute Stroke ◽

Clinical Data ◽

Area Under The Curve ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Deep Learning Neural Network

Background and Purpose: Clinical methods have incomplete diagnostic value for early diagnosis of acute stroke and large vessel occlusion (LVO). Electroencephalography is rapidly sensitive to brain ischemia. This study examined the diagnostic utility of electroencephalography for acute stroke/transient ischemic attack (TIA) and for LVO. Methods: Patients (n=100) with suspected acute stroke in an emergency department underwent clinical exam then electroencephalography using a dry-electrode system. Four models classified patients, first as acute stroke/TIA or not, then as acute stroke with LVO or not: (1) clinical data, (2) electroencephalography data, (3) clinical+electroencephalography data using logistic regression, and (4) clinical+electroencephalography data using a deep learning neural network. Each model used a training set of 60 randomly selected patients, then was validated in an independent cohort of 40 new patients. Results: Of 100 patients, 63 had a stroke (43 ischemic/7 hemorrhagic) or TIA (13). For classifying patients as stroke/TIA or not, the clinical data model had area under the curve=62.3, whereas clinical+electroencephalography using deep learning neural network model had area under the curve=87.8. Results were comparable for classifying patients as stroke with LVO or not. Conclusions: Adding electroencephalography data to clinical measures improves diagnosis of acute stroke/TIA and of acute stroke with LVO. Rapid acquisition of dry-lead electroencephalography is feasible in the emergency department and merits prehospital evaluation.

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Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion

10.21203/rs.2.9582/v1 ◽

2019 ◽

Author(s):

Tianli Zhang ◽

Weirong Li ◽

Xiaolong Wang ◽

Chao Wen ◽

Feng Zhou ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Area Under The Curve ◽

Large Vessel ◽

Multivariable Logistic Regression Analysis ◽

Large Vessel Occlusion ◽

Short Term ◽

Vessel Occlusion ◽

Blood Pressures ◽

The Relationship

Abstract Background: Endovascular treatment (EVT) is advocated for acute ischemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging.This study investigated the relationship between post-EVT short-term blood pressure variability (BPV) and early outcomes in LVO patients. Methods: We retrospectively reviewed 72 LVO patients undergoing EVT between June 2015 and June 2018. Hourly systolic and diastolic blood pressures (SBP and DBP, respectively) were recorded in the first 24 hours post-EVT. BPV were evaluated as standard deviation (SD), coefficient of variation (CV), and successive variation (SV) separately for SBP and DBP. Patients were categorized into favorable (mRS 0-2) and unfavorable (mRS 3-6) outcome groups based on 3-month modified Rankin Scale (mRS) scores. Results: For 58.3% patients with favorable outcomes, median National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores on admission were 14 and 8, respectively. The maximum SBP ([154.3±16.8] vs. [163.5±15.6], P=0.02), systolic CV ([8. 8%±2.0%] vs. [11.0%±1.8%], P<0.001), SV ([11.4±2.3] vs. [14.6±2.0], P<0.001), and SD ([10.5±2.4] vs. [13.8±3.9], P<0.001) were lower in patients with favorable outcomes. On multivariable logistic regression analysis, systolic SV (OR: 4.273, 95% CI: 1.030 to 17.727, P=0.045) independently predicted unfavorable prognosis (area under the curve = 0.868 [95% CI: 0.781 to 0.955, P<0.001]. Sensitivity and specificity were 93.3% and 73.8%, respectively, showing excellent value for 3-month-poor-outcome predictions. Conclusions: Decreased maximum SBP and systolic CV, SV, and SD following intra-arterial therapies result in favorable 3-month outcomes. Systolic SV may be a novel predictor of functional prognosis in LVO patients.

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Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion

10.21203/rs.2.9582/v3 ◽

2019 ◽

Author(s):

Tianli Zhang ◽

Xiaolong Wang ◽

Chao Wen ◽

Feng Zhou ◽

Shengwei Gao ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Area Under The Curve ◽

Functional Independence ◽

Large Vessel ◽

Multivariable Logistic Regression Analysis ◽

Large Vessel Occlusion ◽

Short Term ◽

Vessel Occlusion ◽

Poor Outcomes

Abstract Background : Endovascular treatment (EVT) is advocated for acute ischaemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging. This study investigated the relationship between post-EVT short-term blood pressure variability (BPV) and early outcomes in LVO patients. Methods : We retrospectively reviewed 72 LVO patients undergoing EVT between June 2015 and June 2018. Hourly systolic and diastolic blood pressures (SBP and DBP, respectively) were recorded in the first 24 hours post-EVT. BPV were evaluated as standard deviation (SD), coefficient of variation (CV), and successive variation (SV) separately for SBP and DBP. Functional independence at 3 months was defined as a modified Rankin Scale (mRS) score of 0-2. Results : For 58.3% patients with favorable outcomes, the median National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores on admission were 14 and 8, respectively. The maximum SBP ([154.3±16.8] vs. [163.5±15.6], P=0.02), systolic CV ([8. 8%±2.0%] vs. [11.0%±1.8%], P<0.001), SV ([11.4±2.3] vs. [14.6±2.0], P<0.001), and SD ([10.5±2.4] vs. [13.8±3.9], P<0.001) were lower in patients with favorable outcomes. On multivariable logistic regression analysis, systolic SV (OR: 4.273, 95% CI: 1.030 to 17.727, P=0.045) independently predicted unfavorable prognosis. The area under the curve was 0.868 (95% CI: 0.781 to 0.955, P<0.001), and sensitivity and specificity were 93.3% and 73.8%, respectively, showing excellent predictive value for 3-month poor-outcomes. Conclusions : Decreased systolic SV following intra-arterial therapies result in favorable outcomes at 3 months. Systolic SV may be a novel predictor of functional prognosis in LVO patients.

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