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Updated: Apr 27, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Pittsburgh outcomes after stroke thrombectomy score predicts outcomes after endovascular therapy for anterior
Srikant Rangaraju1, John T P Liggins1, Amin Aghaebrahim1
1From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
Insights
A new tool, the Pittsburgh Outcomes After Stroke Thrombectomy (POST) score, accurately predicts good outcomes for stroke patients undergoing endovascular therapy. This score helps in prognostication for anterior circulation large vessel occlusions.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Prognostication tools for anterior circulation large vessel occlusions (LVO) after endovascular therapy are limited.
- Predicting outcomes is crucial for guiding treatment decisions and managing patient expectations.
Purpose of the Study:
- To develop and validate a clinical and imaging-based tool for predicting outcomes in patients with anterior circulation LVO treated with endovascular therapy.
- To create a simple scoring system for prognostication.
Main Methods:
- Logistic regression analysis was used on a derivation cohort (n=247) of anterior circulation LVO stroke patients treated within 8 hours.
- Independent predictors of good outcome (90-day mRS 0-2) were identified and weighted to form the POST score.
- The POST score was validated in multiple cohorts, including institutional databases, DEFUSE-2, extended time windows, and octogenarians.
Main Results:
- Key predictors of good outcome included final infarct volume, age, and parenchymal hematoma type.
- The POST score formula is: age + 0.5 × final infarct volume + 15 × H.
- High POST scores (<60) indicated a 91% chance of good outcome, while low scores (≥120) indicated a 4% chance.
- The POST score demonstrated strong predictive accuracy across derivation and validation cohorts (AUCs ranging from 0.76 to 0.86).
- POST outperformed the iSCORE in predictive accuracy for both good and poor outcomes.
Conclusions:
- The Pittsburgh Outcomes After Stroke Thrombectomy (POST) score is a validated and accurate tool for predicting outcomes.
- POST provides reliable prognostication for patients with anterior circulation LVO undergoing endovascular therapy.
- This score can aid clinicians in assessing prognosis for stroke patients treated with thrombectomy.
Background And Purpose:
Prognostication tools that predict good outcome in patients with anterior circulation large vessel occlusions after endovascular therapy are lacking. We aim to develop a tool that incorporates clinical and imaging data to predict outcomes after endovascular therapy.
Methods:
In a derivation cohort of anterior circulation large vessel occlusion stroke patients treated with endovascular therapy within 8 hours from time last seen well (n=247), we performed logistic regression to identify independent predictors of good outcome (90-day modified Rankin Scale, 0-2). Factors were weighted based on β-coefficients to derive the Pittsburgh Outcomes After Stroke Thrombectomy (POST) score. POST was validated in an institutional endovascular database (University of Pittsburgh Medical Center, n=393) and the Diffusion-Weighted Imaging Evaluation for Understanding Stroke Evolution Study-2 (DEFUSE-2) data set (n=105), as well as in patients treated beyond 8 hours (n=194) and in octogenarians (n=111).
Results:
In the derivation cohort, independent predictors (P<0.1) of good outcome included 24- to 72-hour final infarct volume (in cm(3), P<0.001), age (years, P<0.001), and parenchymal hematoma types 1 and 2 (H, P=0.01). POST was calculated as age+0.5×final infarct volume+15×H. Patients with POST score <60 had a 91% chance of good outcome compared with 4% with POST score ≥120. POST accurately predicted good outcomes in the derivation (area under the curve [AUC]=0.85) and validation cohorts (University of Pittsburgh Medical Center, AUC=0.81; DEFUSE-2, AUC=0.86), as well as in patients treated beyond 8 hours (AUC, 0.85) and octogenarians (AUC=0.76). POST had better predictive accuracy for good and poor outcome than the ischemic stroke predictive risk score (iSCORE).
Conclusions:
POST score is a validated predictor of outcome in patients with anterior circulation large vessel occlusions after endovascular therapy.
