Use of Machine Learning Algorithms to Predict the Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Patients With an Extended Therapeutic Time Window

Objective The aim of this study was to evaluate the performance of machine learning (ML) algorithms in predicting the functional outcome of mechanical thrombectomy (MT) outside the 6-hour therapeutic time window in patients with acute ischemic stroke (AIS). Methods One hundred seventy-seven consecutive AIS patients with large-vessel occlusion in the anterior circulation who underwent MT in the extended time window were enrolled. Clinical, neuroimaging, and treatment variables that could be obtained quickly in the real-world emergency settings were collected. Four machine learning algorithms (random forests, regularized logistic regression, support vector machine, and naive Bayes) were used to predict good outcomes (modified Rankin Scale scores of 0–2) at 90 days by using (1) only variables at admission and (2) both baseline and treatment variables. The performance of each model was evaluated using receiver operating characteristic (ROC) curve analysis. Feature importance was ranked using random forest algorithms. Results Eighty patients (45.2%) had a favorable 90-day outcome. Machine learning models including baseline clinical and neuroimaging characteristics predicted 90-day modified Rankin Scale with an area under the ROC curve of 0.80–0.81, sensitivity of 0.60–0.71 and specificity of 0.71–0.76. Further inclusion the treatment variables significantly improved the predictive performance (mean area under the ROC curve, 0.89–0.90; sensitivity, 0.77–0.85; specificity, 0.75–0.87). The most important characteristics for predicting 90-day outcomes were age, hypoperfusion intensity ratio at admission, and National Institutes of Health Stroke Scale score at 24 hours after MT. Conclusions Machine learning algorithms may facilitate prediction of 90-day functional outcomes in AIS patients with an extended therapeutic time window.