Mechanical thrombectomy has become the standard of care in patients with stroke due to large vessel occlusion (LVO). However, only 50% of successfully treated patients show a favorable outcome indicating a gap of current treatment decisions which lack individualized guidance based on patient-specific characteristics. We present interpretable deep learning models to predict functional outcome in terms of the modified Rankin Scale alongside individualized treatment effects (ITEs) using data of 449 LVO stroke patients from a randomized clinical trial. Besides clinical variables, we integrated non-contrast CT (NCCT) and angiography (CTA) scans using foundation models to make use of advanced imaging information. Clinical variables had a good predictive power for binary functional outcome prediction (AUC of 0.719 [0.666, 0.774]) which could slightly be improved when adding CTA imaging (AUC of 0.737 [0.687, 0.795]). Adding NCCTs or a combination of NCCT and CTA scans to clinical features yielded no improvement. The most important clinical predictor for functional outcome was pre-stroke disability. While estimated ITEs were well calibrated to the average treatment effect, discriminatory ability was limited indicated by a C-for-Benefit statistic of around 0.55 in all models. In summary, the models allowed us to jointly integrate CT imaging and clinical features while achieving state-of-the-art prediction performance and ITE estimates. Yet, further research is needed to particularly improve ITE estimation.

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Outcome Prediction and Individualized Treatment Effect Estimation in Patients with Large Vessel Occlusion Stroke

  • Lisa Herzog,
  • Pascal Bühler,
  • Ezequiel de la Rosa,
  • Beate Sick,
  • Susanne Wegener

摘要

Mechanical thrombectomy has become the standard of care in patients with stroke due to large vessel occlusion (LVO). However, only 50% of successfully treated patients show a favorable outcome indicating a gap of current treatment decisions which lack individualized guidance based on patient-specific characteristics. We present interpretable deep learning models to predict functional outcome in terms of the modified Rankin Scale alongside individualized treatment effects (ITEs) using data of 449 LVO stroke patients from a randomized clinical trial. Besides clinical variables, we integrated non-contrast CT (NCCT) and angiography (CTA) scans using foundation models to make use of advanced imaging information. Clinical variables had a good predictive power for binary functional outcome prediction (AUC of 0.719 [0.666, 0.774]) which could slightly be improved when adding CTA imaging (AUC of 0.737 [0.687, 0.795]). Adding NCCTs or a combination of NCCT and CTA scans to clinical features yielded no improvement. The most important clinical predictor for functional outcome was pre-stroke disability. While estimated ITEs were well calibrated to the average treatment effect, discriminatory ability was limited indicated by a C-for-Benefit statistic of around 0.55 in all models. In summary, the models allowed us to jointly integrate CT imaging and clinical features while achieving state-of-the-art prediction performance and ITE estimates. Yet, further research is needed to particularly improve ITE estimation.