{"doi":"10.1161/strokeaha.124.050020","title":"Individualized MRI-Based Stroke Prediction Score Using Plaque Vulnerability for Symptomatic Carotid Artery Disease Patients (IMPROVE)","abstract":"BACKGROUND: In symptomatic carotid stenosis, treatment decisions are currently primarily based on stenosis degree. We developed a clinical prediction model (Individualized Magnetic Resonance Imaging-Based Stroke Prediction Score Using Plaque Vulnerability for Patients With Symptomatic Carotid Artery Disease [IMPROVE]) incorporating the strong predictor, intraplaque hemorrhage on magnetic resonance imaging, stenosis degree, and risk factors to identify patients with high stroke risk. METHODS: IMPROVE was developed on data from 5 cohorts of 760 patients with symptomatic carotid disease on optimal medical treatment. Inclusion criteria included a recent transient ischemic attack/stroke (<6 months), magnetic resonance imaging-based information on intraplaque hemorrhage, no atrial fibrillation, and no immediate revascularization. IMPROVE was based on Cox regression using 5 expert-selected predictors and converted to 3-year ipsilateral ischemic stroke risk after internal validation. IMPROVE-based stratification was compared with care-as-usual using illustrative cutoffs: high risk was defined in IMPROVE as ≥ median 3-year IMPROVE risk, whereas in care-as-usual, it was ≥50% carotid stenosis. RESULTS: Sixty-five ipsilateral ischemic strokes occurred during a median follow-up of 1.2 years (interquartile range, 0.5-4.1). The IMPROVE model includes 5 predictors (hazard ratio [95% CI]): degree of stenosis (<50%: reference, 50%-69%: 4.54 [2.46-8.38], 70%-99% stenosis: 7.42 [3.45-15.95]), presence of intraplaque hemorrhage (5.61 [2.92-10.77]), classification of last event (ocular: reference, cerebral: 3.72 [1.11-12.52]), male sex (1.26 [0.64-2.48]), and age (1.14 [0.84-1.55] per 10-year increase). Internal validation revealed good accuracy (C statistic, 0.82 [95% CI, 0.77-0.87]) and no evidence of miscalibration (calibration slope, 0.93). Sensitivity for the illustrative IMPROVE cutoff was 92.6% (90.7-94.5) versus 80.6% (77.8-83.4) for care-as-usual. Specificity was 54.2% (50.7-57.8) for IMPROVE versus 52.9% (49.3-56.4) for care-as-usual. Patients stratified by IMPROVE as high risk had a higher incidence of ipsilateral ischemic stroke (24.0%) compared with the care-as-usual classification (20.7%). Among patients classified as lower-risk by IMPROVE and care-as-usual, 2.1% and 5.3%, respectively, experienced an ipsilateral ischemic stroke during follow-up. CONCLUSIONS: Using the presence of intraplaque hemorrhage on magnetic resonance imaging and 4 conventional parameters, the IMPROVE model provides accurate individual stroke risk estimates, which may facilitate stratification for revascularization after external validation.","journal":"Stroke","year":2025,"id":511278,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9557,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":104043,"name":"Luc Smits","orcid":"0000-0003-0785-1345","position":1,"is_corresponding":false},{"id":104048,"name":"Sander M. J. van Kuijk","orcid":"0000-0003-2796-729X","position":2,"is_corresponding":false},{"id":1224234,"name":"Akram A. Hosseini","orcid":"0000-0003-0133-9842","position":3,"is_corresponding":false},{"id":560473,"name":"Dianne H.K. van Dam-Nolen","orcid":"0000-0002-4527-3876","position":4,"is_corresponding":false},{"id":751284,"name":"Robert M. Kwee","orcid":"0000-0001-7760-867X","position":5,"is_corresponding":false},{"id":1333759,"name":"Yoshitaka Kurosaki","orcid":null,"position":6,"is_corresponding":false},{"id":1333760,"name":"Iris Rupert","orcid":null,"position":7,"is_corresponding":false},{"id":85620,"name":"Paul J. Nederkoorn","orcid":null,"position":8,"is_corresponding":false},{"id":21747,"name":"Pim A. de Jong","orcid":"0000-0003-4840-6854","position":9,"is_corresponding":false},{"id":560478,"name":"Daniël Bos","orcid":"0000-0001-8979-2603","position":10,"is_corresponding":false},{"id":1333761,"name":"Sen Yamagata","orcid":null,"position":11,"is_corresponding":false},{"id":626020,"name":"Dorothee P. Auer","orcid":"0000-0002-4745-3635","position":12,"is_corresponding":false},{"id":1333391,"name":"Andreas Schindler","orcid":"0000-0003-0183-5782","position":13,"is_corresponding":false},{"id":678409,"name":"Tobias Saam","orcid":"0000-0003-1969-1641","position":14,"is_corresponding":false},{"id":85663,"name":"Robert J. van Oostenbrugge","orcid":"0000-0003-1032-9099","position":15,"is_corresponding":false},{"id":678411,"name":"M. Eline Kooi","orcid":"0000-0001-7562-5724","position":16,"is_corresponding":false},{"id":1333390,"name":"Kelly Nies","orcid":"0000-0002-9457-3306","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-19T02:47:55.918021Z","pmid":"40336502","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}