• Hernan A Bazan, Daniel Fort, Larry Snyder, Frank G Opelka, Samuel R Money, W C Sternbergh, and Jeffrey Burton.
• - Section of Vascular/Endovascular Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA.
• J. Am. Coll. Surg. 2025 Jan 17.

BackgroundStroke requires timely intervention, with carotid endarterectomy (CEA) and carotid artery stenting (CAS) increasingly used in select acute carotid-related stroke patients. We aimed to build a model to predict neurologic functional independence (modified Rankin scale, mRS ≤ 2) in this high-risk group.Study DesignWe analyzed data from 302 stroke patients undergoing urgent CEA or CAS between 2015 and 2023 at a tertiary Comprehensive Stroke Center. Predictors included: (1) stroke severity (NIH Stroke Scale, NIHSS), (2) time to intervention (≤48 hours), (3) thrombolysis use, and (4) frailty risk score. Two-way interactions were included to enhance generalizability without overfitting. Multiple models were constructed and selected based on the area under the ROC curve (AUC). The primary endpoint was discharge neurological functional independence (mRS ≤2).ResultsPresenting clinical factors and neurological outcomes data from 302 patients undergoing urgent CEA and CAS during the index hospitalization from 2015 to 2023 at a tertiary Comprehensive Stroke Center formed the model's foundation. Most patients (72.8%, 220/302) were discharged functionally independent (mRS ≤ 2). The combined 30-day rate of stroke, death, and MI was 8.3% (25/302); 6.5% (14/214) for CEA alone, and 12.5% (11/88) for CAS. The model, incorporating thrombolysis, time to intervention, stroke severity (NIHSS), and frailty risk, correctly predicted 93% of functional independence outcomes (AUC 0.808).ConclusionWe present a novel model using four clinical factors-stroke severity, time to intervention, thrombolysis use, and frailty risk-to predict functional neurologic independence with 93% accuracy in patients undergoing urgent carotid interventions for acute stroke. This high predictive capability can enhance clinical decision-making and improve patient outcomes by identifying those most likely to benefit from timely carotid revascularization.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Surgeons.

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