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Updated: Jan 5, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Risk Stratification for Endovascular Treatment in Acute Anterior Circulation Occlusive Stroke
Yunyun Xiong1, Huaiming Wang2, Meng Zhang3
1Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Insights
A new scoring system, the Risk strAtification for eNdovascular treatment in acute anterior circulation occlusive stroKe (RANK) scale, effectively stratifies risk for acute stroke patients undergoing endovascular treatment. This validated tool aids in predicting outcomes for anterior circulation large vessel occlusion stroke.
Area of Science:
- Neurology
- Interventional Cardiology
- Public Health
Background:
- Acute anterior circulation large vessel occlusion stroke requires precise risk stratification for effective endovascular treatment.
- Current methods may not fully capture the complexity of patient risk profiles.
- Accurate prognostication is crucial for guiding treatment decisions and resource allocation.
Purpose of the Study:
- To develop and validate a novel scoring system, the Risk strAtification for eNdovascular treatment in acute anterior circulation occlusive stroKe (RANK) scale.
- To improve risk stratification for patients with acute anterior circulation large vessel occlusion stroke undergoing endovascular therapy.
Main Methods:
- A multicenter registry of acute ischemic stroke patients undergoing thrombectomy in China was utilized.
- Patients were divided into derivation (two-thirds) and validation (one-third) cohorts.
- Multivariable logistic regression was employed to develop the scoring system, with model performance assessed using AUC and the Hosmer-Lemeshow test.
Main Results:
- The RANK scale demonstrated good discrimination in both derivation (AUC = .79) and validation (AUC = .74) cohorts.
- The scale showed good calibration in the validation cohort (P = .54).
- Five risk categories were defined, with very high-risk patients having a low rate of good functional outcomes (3.3% derivation, 5.5% validation).
Conclusions:
- The novel RANK scale is a validated tool for risk stratification in endovascular stroke treatment.
- It provides a reliable method for assessing risk in anterior circulation large vessel occlusion stroke.
- The scale aids in predicting functional outcomes, supporting clinical decision-making.
Objective:
To develop and validate a novel scoring system for risk stratification in acute anterior circulation large vessel occlusion stroke patients undergoing endovascular treatment.
Methods:
Subjects were included from a multicenter registry on acute ischemic stroke undergoing thrombectomy in China. Two thirds of the patients were used as the derivation group and the other one third of the patients as the validation group. Multivariable logistic regression was used to generate the scoring system. The area under the receiver operating characteristic curve and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration, respectively.
Results:
The Risk strAtification for eNdovascular treatment in acute anterior circulation occlusive stroKe (RANK) scale (total score ranges from -11 to 14) showed good discrimination in the derivation cohort (AUC = .79; 95% confidence interval [CI], .74-.84) and validation cohorts (AUC = .74; 95% CI, .68-.81), as well as good calibration (Hosmer-Lemeshow test) in the validation cohort (P = .54). We categorized the RANK score into 5 predictive groups for an unfavorable functional outcome, less than or equal to -8 (very low risk), -7 to -4 (low risk), -3 to 0 (intermediate), 1-5 (high risk), and greater than or equal to 6 (very high risk). In the very high risk group, only 3.3% (1 of 30, 95% CI: .08%-.2%) of patients in the derivation group and 5.5% (1 of 18, 95% CI: .1%-.3%) of patients in the validation group achieved a good functional outcome at day 90.
Conclusions:
The novel scale is a valid tool for risk stratification for endovascular stroke treatment in anterior circulation large vessel occlusions.
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