Proposed Prognostic Tool for Stroke May Help Identify High Risk Patients

Findings published in Neurological Sciences demonstrate the efficacy of a novel practical prognostic model for acute ischemic stroke, which integrates vascular aging markers with clinical severity to predict post-stroke outcomes. Researchers found that arterial stiffness—measured by estimated pulse wave velocity (ePWV)—was a strong, independent predictor of poor functional recovery, and that combining ePWV with the National Institutes of Health Stroke Scale (NIHSS) significantly improved prognostic accuracy.

The multicenter study included 2730 patients who underwent 24-hour ambulatory blood pressure monitoring after stroke onset. Investigators evaluated 3 vascular aging indices—ePWV, early vascular aging ambulatory score (EVAAs), and 24-hour pulse pressure (24h-PP)—and analyzed their association with poor functional outcome, defined as a modified Rankin Scale score >2 at 3 months.

Key findings:

• ePWV demonstrated the strongest predictive value (area under the curve [AUC]=0.77; 95% CI, 0.74 to 0.79).
• The optimal cutoff points for predicting poor functional outcome were 12.2 m/s for ePWV (79.4% sensitivity, 61.7% specificity), 65% for EVAAs (66.4% sensitivity, 51.5% specificity), and 51.1 mmHg for 24 h-PP (66.7% sensitivity, 46.6% specificity).
• A new composite Severity and Arterial Stiffness (SASt) score (NIHSS + 2 × ePWV) achieved the best performance (AUC=0.87; 95% CI, 0.85 to 0.88).

According to the authors, incorporating vascular aging measures like ePWV into post-stroke risk models may improve early prognostication and help identify patients at higher risk of poor recovery, though prospective validation is needed before clinical adoption.

Source: Kakaletsis, N., Protogerou, A.D., Hosomi, N. et al. Impact of vascular aging on stroke prognosis: the novel severity and arterial stiffness (SASt) score. Neurol Sci (2025). https://doi.org/10.1007/s10072-025-08527-7