Background: Nearly half of the patients who received endovascular thrombectomy (EVT) for large vessel occlusion experience poor functional outcomes. Reliable tools for early post-procedural prognostication are needed. We aimed to assess and compare the performance of existing, pragmatic post-EVT prognostic scores in a large national multicenter cohort. Methods: We conducted a systematic literature search to identify pragmatic post-thrombectomy prognostic scores predicting 90-day functional outcomes. Models relying on advanced imaging, small derivation samples, or machine learning were excluded. We analyzed data from the IRETAS registry-a prospective, multicenter Italian cohort of stroke patients treated with EVT. Inclusion criteria were pre-stroke modified Rankin Scale (mRS) ⩽ 2 and available 90-day mRS. The primary outcome was good functional outcome (mRS ⩽ 2). Prognostic performance was assessed using c-statistics in the samples where each individual score was measurable. Scores were compared using DeLong tests in the subset of patients for whom all scores were measurable. Results: Three scores were identified: HERMES-24, BET, and SNARL. Among 22,768 patients in the registry, 18,408 (89.1%) had a measurable HERMES-24 score, 13,593 (59.7%) had a measurable BET score, and 19,007 (83.5%) had a measurable SNARL score. Median age was 75 years (IQR 65-82), and 11,528 (50.6%) were female. In the subset in which each test was measurable, HERMES-24 showed the best performance for predicting mRS ⩽ 2 (c-statistic = 0.889), followed by BET (c-statistic = 0.794) and SNARL (c-statistic = 0.762) (p < 0.001). In the subset of 12,233 patients for whom all three prognostic scores were calculable, a head-to-head comparison confirmed the superior performance of the HERMES-24 model: HERMES-24 score versus BET score (c-statistic difference = 0.098 [95% CI = 0.092-0.105]; p < 0.001) and HERMES-24 score versus SNARL score (c-statistic difference = 0.124 [95% CI = 0.116-0.132]; p < 0.001). Conclusions: In this large, multicenter, national cohort, the post-EVT HERMES-24 score-which accounts only for age and 24-h NIHSS-demonstrated the highest prognostic performance among existing, pragmatic post-EVT scores. Its simplicity and robust performance support its routine adoption in clinical practice.
Comparison of pragmatic post-thrombectomy prognostic scores not based on advanced imaging in a large national stroke registry / Ciacciarelli, A; Pensato, U; Pracucci, G; Saia, V; Nicolini, E; De Michele, M; Fasolino, Ca; Fainardi, E; Casetta, I; Marcheselli, S; Laiso, A; Nencini, P; Vallone, S; Bigliardi, G; Da Ros, V; Maestrini, I; Bergui, M; Bosco, G; Ruggiero, M; Longoni, M; Bracco, S; Tassi, R; Simonetti, L; Zini, A; Del Sette, B; Benzi Markushi, T; Tessitore, A; Ferraù, L; Menozzi, R; Pezzini, A; Saletti, A; De Vito, A; Boghi, A; Naldi, A; Lazzarotti, Ga; Giannini, N; Milazzo, N; Persico, A; Plebani, M; Cappellari, M; Comai, A; Franchini, E; Burdi, N; Boero, G; Allegretti, L; Tassinari, T; Zimatore, Ds; Petruzzellis, M; Cavasin, N; Critelli, A; Lozupone, E; Caggiula, M; Gallesio, I; Ferrandi, D; Puglielli, E; Casalena, A; Perri, M; De Santis, F; Besana, M; Giossi, A; Galvano, G; Saracco, E; Carità, G; Russo, M; Allegritti, M; Caproni, S; Alberti, M; Invernizzi, P; Filizzolo, M; Mannino, M; Pelle, G; Alessiani, M; Konda, D; Sallustio, F; Mangiafico, S; Toni, D. - In: INTERNATIONAL JOURNAL OF STROKE. - ISSN 1747-4930. - (2026). [10.1177/17474930261421043]
Comparison of pragmatic post-thrombectomy prognostic scores not based on advanced imaging in a large national stroke registry
Pezzini A;
2026-01-01
Abstract
Background: Nearly half of the patients who received endovascular thrombectomy (EVT) for large vessel occlusion experience poor functional outcomes. Reliable tools for early post-procedural prognostication are needed. We aimed to assess and compare the performance of existing, pragmatic post-EVT prognostic scores in a large national multicenter cohort. Methods: We conducted a systematic literature search to identify pragmatic post-thrombectomy prognostic scores predicting 90-day functional outcomes. Models relying on advanced imaging, small derivation samples, or machine learning were excluded. We analyzed data from the IRETAS registry-a prospective, multicenter Italian cohort of stroke patients treated with EVT. Inclusion criteria were pre-stroke modified Rankin Scale (mRS) ⩽ 2 and available 90-day mRS. The primary outcome was good functional outcome (mRS ⩽ 2). Prognostic performance was assessed using c-statistics in the samples where each individual score was measurable. Scores were compared using DeLong tests in the subset of patients for whom all scores were measurable. Results: Three scores were identified: HERMES-24, BET, and SNARL. Among 22,768 patients in the registry, 18,408 (89.1%) had a measurable HERMES-24 score, 13,593 (59.7%) had a measurable BET score, and 19,007 (83.5%) had a measurable SNARL score. Median age was 75 years (IQR 65-82), and 11,528 (50.6%) were female. In the subset in which each test was measurable, HERMES-24 showed the best performance for predicting mRS ⩽ 2 (c-statistic = 0.889), followed by BET (c-statistic = 0.794) and SNARL (c-statistic = 0.762) (p < 0.001). In the subset of 12,233 patients for whom all three prognostic scores were calculable, a head-to-head comparison confirmed the superior performance of the HERMES-24 model: HERMES-24 score versus BET score (c-statistic difference = 0.098 [95% CI = 0.092-0.105]; p < 0.001) and HERMES-24 score versus SNARL score (c-statistic difference = 0.124 [95% CI = 0.116-0.132]; p < 0.001). Conclusions: In this large, multicenter, national cohort, the post-EVT HERMES-24 score-which accounts only for age and 24-h NIHSS-demonstrated the highest prognostic performance among existing, pragmatic post-EVT scores. Its simplicity and robust performance support its routine adoption in clinical practice.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
