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Updated: May 16, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Real-World Validation of the HERMES-24 Score for Outcome Prediction After Large Vessel Occlusion Treatment in Late
Omid Shirvani1,2, Felix J Bode1, Sebastian Stösser1
1Department of Vascular Neurology, University Hospital Bonn, Germany.
Objectives:
The HERMES-24 score recently demonstrated high accuracy for outcome prediction after large vessel occlusion (LVO) treatment in late time window patients from randomized clinical trials. In this study, we externally validate the score in a real-world patient cohort.
Methods:
Data from German Stroke Registry patients with LVO treated with endovascular therapy beyond 6 hours from symptom onset or last seen well were used. We performed a complete case analysis, excluding functionally dependent patients (premorbid modified Rankin Scale [mRS] >2/>3 for prediction of mRS ≤2/≤3, respectively). We assessed the HERMES-24 score for 90-day mRS prediction using bootstrap resampling and the c-statistic.
Results:
The analyzed cohort comprised 2,117 patients (mean age 74 ± 13.3 years; 55.4% female; median admission NIH Stroke Scale (NIHSS) 14 (Q1-Q3: 9-18)). The HERMES-24 score achieved an area under the curve (AUC) of 0.876 (95% CI 0.859-0.889) for mRS ≤2 and 0.856 (95% CI 0.837-0.875) for mRS ≤3. Subgroup analysis for mRS ≤2 prediction showed lower performance in patients with NIHSS <18 (AUC 0.850, 95% CI 0.832-0.870).
Discussion:
In our real-world cohort of late time window patients with LVO, the HERMES-24 score showed good discriminative performance, supporting its cautious clinical applicability, considering its lower performance than in trial populations, especially in patients with lower baseline NIHSS scores.