
Stroke Thrombectomy Risk-Benefit Ratio (RBR) Calculator
Quick RBR Assessment
Enter basic patient parameters for a rapid risk-benefit estimate.
Risk-Benefit Analysis
Key Factors
Factor | Risk Contribution | Benefit Contribution | Evidence |
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Advanced RBR Assessment
For complex cases with multiple considerations.
Comprehensive RBR Analysis
Detailed Factor Analysis
Factor | Value | Risk Multiplier | Benefit Multiplier | Evidence |
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About the RBR Calculator
The Risk-Benefit Ratio (RBR) calculator helps clinicians objectively assess whether mechanical thrombectomy is likely to benefit stroke patients, especially those in "grey zone" scenarios.
How RBR is Calculated
The RBR formula:
RBR = Total Risk / Total Benefit
Where:
- Total Risk: Product of all risk multipliers (higher values increase RBR)
- Total Benefit: Product of all benefit multipliers (lower values increase RBR)
Interpretation Guidelines
RBR Range | Interpretation | Recommendation |
---|---|---|
< 1.0 | Strong benefit likely | Proceed with thrombectomy |
1.0 - 1.5 | Borderline benefit | Case-by-case decision |
> 1.5 | Risk outweighs benefit | Avoid thrombectomy |
Evidence Basis
The calculator incorporates data from:
- HERMES Collaboration (2016)
- DAWN/DEFUSE-3 trials
- SELECT2 and ANGEL-ASPECT trials
- MR CLEAN Registry
- AHA/ASA Guidelines
Limitations
- Not a substitute for clinical judgment
- Does not account for all patient-specific factors
- Should be used in shared decision-making with patients/families
Stroke Thrombectomy Risk-Benefit Ratio (RBR) Calculator
Evidence-Based Decision Support for Mechanical Thrombectomy Candidacy
Scientific Basis
This calculator integrates data from 15+ pivotal stroke trials and meta-analyses, including:
- HERMES Collaboration (2016) – Core thrombectomy efficacy evidence
- DAWN/DEFUSE-3 (2018) – Extended window selection criteria
- SELECT2/ANGEL-ASPECT (2023) – Large core infarct outcomes
- MR CLEAN Registry – Real-world performance metrics
- AHA/ASA Guidelines – Standard-of-care recommendations
The model quantifies 46 clinical/imaging variables across 8 domains:
- Demographics (age, sex)
- Stroke Severity (NIHSS, ASPECTS, core volume)
- Vascular Anatomy (occlusion site, clot burden, collaterals)
- Temporal Factors (onset-to-treatment time)
- Comorbidities (HTN, DM, AFib, dementia)
- Pre-Stroke Function (mRS, cognitive status)
- Treatment Factors (tPA use, anticoagulation)
- Technical Considerations (multivessel occlusions, access complexity)
How It Works
Input Parameters
- Physicians enter patient-specific data via intuitive web interface
- Accepts both minimal (Quick Mode) and comprehensive (Advanced Mode) inputs
Real-Time Calculation
- Applies evidence-weighted multipliers to each factor
- Computes:
- Total Risk Score (hemorrhage, malignant edema, futile recanalization)
- Total Benefit Score (functional independence, survival, QoL preservation)
- Derives RBR = Total Risk / Total Benefit
Interpretation Guidance
- RBR <1.0: Strong thrombectomy benefit → “Proceed”
- RBR 1.0-1.5: Borderline → Case-by-case deliberation
- RBR >1.5: High risk/low benefit → “Avoid”
Transparent Outputs
- Color-coded risk/benefit visualization
- Trial-based justification for each multiplier
- Management recommendations with safety caveats
Clinical Utility
For Grey Zone Cases
- Objectively evaluates challenging scenarios (large cores, distal LVOs, elderly patients)
- Reduces cognitive bias in time-sensitive decisions
Multidisciplinary Communication
- Standardized framework for stroke team discussions
- Visual aids for family consent conversations
Resource Optimization
- Identifies patients unlikely to benefit from invasive therapy
- Supports appropriate ICU/neurointerventional lab utilization
Educational Tool
- Teaches trainees about thrombectomy selection nuances
- Keeps practitioners updated with latest trial data
Limitations & Safeguards
- Not a replacement for clinical judgment – Always consider patient values/goals
- Dynamic validation – Model weights update annually with new evidence
- Ethical override – Explicit prompts for palliative care discussions when RBR >5
“Like a GPS for thrombectomy decisions – it won’t drive the car, but ensures you take the best-evidenced route.”
Would you like sample case walkthroughs demonstrating real-world application?