German Stroke Registry - Endovascular Treatment

Acute Ischemic Stroke Clinical Trial

— GSR-ET  

Official title:

German Stroke Registry - Endovascular Treatment

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03356392
• Other study ID #: GSR-ET
• Status: Recruiting
• Start date: June 2015
• Est. completion date: June 2025

Study information

• Verified date: November 2022
• Source: Universitätsklinikum Hamburg-Eppendorf
• Contact: Maximilian Schell
• Phone: +49 (0)1522/2834807
• Email: m.schell[@]uke.de
• Is FDA regulated: No
• Study type: Observational [Patient Registry]

Clinical Trial Summary

The German Stroke Registry (GSR) Endovascular Treatment is an academic, independent, prospective, multicentre, observational registry study. Consecutive patients treated with endovascular stroke treatment will be enrolled in German stroke centers. Patients receive regular care and data will be collected as part of clinical routine. Baseline clinical and procedural information as well clinical follow-up information during in-hospital stay, and up to 90 days of stroke onset are collected. Data collected include demographics, National Institute of Health Stroke Scale (NIHSS) on admission, pre-treatment ASPECTS, information on timing and success of interventional treatment, procedural complications, intracranial hemorrhage, and functional outcome.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 10000
• Est. completion date: June 2025
• Est. primary completion date: June 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Clinical diagnosis of acute ischemic stroke
• Eligible for intravenous thrombolysis (IVT) and IVT initiated within 4.5 hours after stroke onset
• Confirmed diagnosis of persistent occlusion of terminal carotid artery, middle cerebral artery (M1 or M2), or basilar artery consistent with symptoms
• Age >18 years
• Ethic approval in process Exclusion Criteria: none

Related Conditions & MeSH terms

• Acute Ischemic Stroke
• Ischemic Stroke
• Stroke

Intervention

Other:
• telephone call d90
telephone call on day 90 to assess the primary outcome (mRs d90)

Locations

Country	Name	City	State
Germany	University Medical Center Hamburg-Eppendorf (UKE)	Hamburg

Sponsors (35)

Lead Sponsor

Collaborator

Universitätsklinikum Hamburg-Eppendorf

Allgemeines Krankenhaus Celle, Asklepios Klinik Altona, Asklepios Klinik Wandsbek, Bezirkskrankenhaus Günzburg, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Charite University, Berlin, Germany, Elbe Kliniken, Klinikum Altenburger Land, Klinikum Bremen-Mitte, gGmbH, Klinikum Dortmund, Klinikum Köln-Merheim, Klinikum Lüneburg, Klinikum Osnabrück, Klinikum rechts der Isar, Technical University of Munich, Klinikum Stadt Hanau, Krankenhaus Buchholz, KRH Klinikum Nordstadt, Ludwig-Maximilians - University of Munich, Mühlenkreiskliniken Minden, radprax MVZ Nordrhein, RWTH Aachen University, Sana Kliniken Lübeck, Sana Klinikum Offenbach, Städtische Klinikum Braunschweig, University Hospital Frankfurt, University Hospital Muenster, University Hospital of Cologne, University Hospital Tuebingen, University Hospital, Bonn, University Medical Center Mainz, University Medical Center Rostock, University of Giessen and Marburg, University of Göttingen, Wuerzburg University Hospital

Country where clinical trial is conducted

Germany, 

References & Publications (40)

Alegiani AC, Dorn F, Herzberg M, Wollenweber FA, Kellert L, Siebert E, Nolte CH, von Rennenberg R, Hattingen E, Petzold GC, Bode FJ, Pfeilschifter W, Schafer JH, Wagner M, Rother J, Eckert B, Kraft P, Pham M, Boeckh-Behrens T, Wunderlich S, Bernkopf K, Reich A, Wiesmann M, Mpotsaris A, Psychogios M, Liman J, Maier I, Berrouschot J, Bormann A, Limmroth V, Spreer J, Petersen M, Krause L, Lowens S, Kraemer C, Zweynert S, Lange KS, Thonke S, Kastrup A, Papanagiotou P, Alber B, Braun M, Fiehler J, Gerloff C, Dichgans M, Thomalla G. Systematic evaluation of stroke thrombectomy in clinical practice: The German Stroke Registry Endovascular Treatment. Int J Stroke. 2019 Jun;14(4):372-380. doi: 10.1177/1747493018806199. Epub 2018 Oct 22. Erratum In: Int J Stroke. 2018 Dec 17;:1747493018816194. Eur J Prev Cardiol. 2020 Nov;27(17):NP16. — View Citation

Broocks G, Hanning U, Bechstein M, Elsayed S, Faizy TD, Brekenfeld C, Flottmann F, Kniep H, Deb-Chatterji M, Schon G, Thomalla G, Kemmling A, Fiehler J, Meyer L; German Stroke Registry-Endovascular Treatment (GSR-ET) Study Group. Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction. JAMA Netw Open. 2022 Oct 3;5(10):e2235733. doi: 10.1001/jamanetworkopen.2022.35733. — View Citation

Broocks G, McDonough R, Bechstein M, Hanning U, Brekenfeld C, Flottmann F, Kniep H, Nawka MT, Deb-Chatterji M, Thomalla G, Sporns P, Yeo LL, Tan BY, Gopinathan A, Kastrup A, Politi M, Papanagiotou P, Kemmling A, Fiehler J, Meyer L; German Stroke Registry - Endovascular Treatment (GSR-ET). Benefit and risk of intravenous alteplase in patients with acute large vessel occlusion stroke and low ASPECTS. J Neurointerv Surg. 2023 Jan;15(1):8-13. doi: 10.1136/neurintsurg-2021-017986. Epub 2022 Jan 25. — View Citation

Burian E, Sepp D, Lehm M, Bernkopf K, Wunderlich S, Riederer I, Maegerlein C, Alegiani A, Zimmer C, Boeckh-Behrens T; GSR-ET Investigators. Start, Stop, Continue? The Benefit of Overlapping Intravenous Thrombolysis and Mechanical Thrombectomy : A Matched Case-control Analysis from the German Stroke Registry. Clin Neuroradiol. 2022 Jul 26. doi: 10.1007/s00062-022-01200-y. Online ahead of print. — View Citation

Deb-Chatterji M, Pinho J, Flottmann F, Meyer L, Broocks G, Brekenfeld C, Reich A, Fiehler J, Gerloff C, Thomalla G; GSR-ET Investigators. Health-related quality of life after thrombectomy in young-onset versus older stroke patients: a multicenter analysis. J Neurointerv Surg. 2022 Nov;14(11):1145-1150. doi: 10.1136/neurintsurg-2021-017991. Epub 2021 Dec 7. — View Citation

Deb-Chatterji M, Pinnschmidt H, Flottmann F, Leischner H, Broocks G, Alegiani A, Brekenfeld C, Fiehler J, Gerloff C, Thomalla G; GSR-ET Investigators. Predictors of independent outcome of thrombectomy in stroke patients with large baseline infarcts in clinical practice: a multicenter analysis. J Neurointerv Surg. 2020 Nov;12(11):1064-1068. doi: 10.1136/neurintsurg-2019-015641. Epub 2020 Feb 27. — View Citation

Deb-Chatterji M, Schlemm E, Flottmann F, Meyer L, Alegiani A, Brekenfeld C, Fiehler J, Gerloff C, Thomalla G; GSR-ET Investigators. Sex Differences in Outcome After Thrombectomy for Acute Ischemic Stroke are Explained by Confounding Factors. Clin Neuroradiol. 2021 Dec;31(4):1101-1109. doi: 10.1007/s00062-020-00983-2. Epub 2020 Dec 21. — View Citation

Feil K, Herzberg M, Dorn F, Tiedt S, Kupper C, Thunstedt DC, Hinske LC, Muhlbauer K, Goss S, Liebig T, Dieterich M, Bayer A, Kellert L; GSR Investigators. General Anesthesia versus Conscious Sedation in Mechanical Thrombectomy. J Stroke. 2021 Jan;23(1):103-112. doi: 10.5853/jos.2020.02404. Epub 2021 Jan 31. — View Citation

Feil K, Herzberg M, Dorn F, Tiedt S, Kupper C, Thunstedt DC, Papanagiotou P, Meyer L, Kastrup A, Dimitriadis K, Liebig T, Dieterich M, Kellert L; GSR investigatorsdagger. Tandem Lesions in Anterior Circulation Stroke: Analysis of the German Stroke Registry-Endovascular Treatment. Stroke. 2021 Apr;52(4):1265-1275. doi: 10.1161/STROKEAHA.120.031797. Epub 2021 Feb 16. — View Citation

Feil K, Kupper C, Tiedt S, Dimitriadis K, Herzberg M, Dorn F, Liebig T, Dieterich M, Kellert L; GSR Investigators. Safety and efficacy of mechanical thrombectomy in infective endocarditis: A matched case-control analysis from the German Stroke Registry-Endovascular Treatment. Eur J Neurol. 2021 Mar;28(3):861-867. doi: 10.1111/ene.14686. Epub 2021 Jan 6. — View Citation

Feil K, Matusevicius M, Herzberg M, Tiedt S, Kupper C, Wischmann J, Schonecker S, Mengel A, Sartor-Pfeiffer J, Berger K, Dimitriadis K, Liebig T, Dieterich M, Mazya M, Ahmed N, Kellert L. Minor stroke in large vessel occlusion: A matched analysis of patients from the German Stroke Registry-Endovascular Treatment (GSR-ET) and patients from the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). Eur J Neurol. 2022 Jun;29(6):1619-1629. doi: 10.1111/ene.15272. Epub 2022 Feb 19. — View Citation

Flottmann F, Brekenfeld C, Broocks G, Leischner H, McDonough R, Faizy TD, Deb-Chatterji M, Alegiani A, Thomalla G, Mpotsaris A, Nolte CH, Fiehler J, Maros ME; GSR investigators*. Good Clinical Outcome Decreases With Number of Retrieval Attempts in Stroke Thrombectomy: Beyond the First-Pass Effect. Stroke. 2021 Jan;52(2):482-490. doi: 10.1161/STROKEAHA.120.029830. Epub 2021 Jan 20. Erratum In: Stroke. 2021 Apr;52(4):e116. — View Citation

Flottmann F, Broocks G, Faizy TD, McDonough R, Watermann L, Deb-Chatterji M, Thomalla G, Herzberg M, Nolte CH, Fiehler J, Leischner H, Brekenfeld C; GSR investigators. Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke : A Multicenter Analysis. Clin Neuroradiol. 2021 Mar;31(1):197-205. doi: 10.1007/s00062-020-00880-8. Epub 2020 Feb 17. — View Citation

Flottmann F, van Horn N, Maros ME, Leischner H, Bechstein M, Meyer L, Sauer M, Deb-Chatterji M, Alegiani A, Thomalla G, Fiehler J, Brekenfeld C; GSR investigators. More Retrieval Attempts are Associated with Poorer Functional Outcome After Unsuccessful Thrombectomy. Clin Neuroradiol. 2022 Jun;32(2):361-368. doi: 10.1007/s00062-021-01054-w. Epub 2021 Jul 8. — View Citation

Flottmann F, van Horn N, Maros ME, McDonough R, Deb-Chatterji M, Alegiani A, Thomalla G, Hanning U, Fiehler J, Brekenfeld C; GSR investigators. Early TICI 2b or Late TICI 3-Is Perfect the Enemy of Good? Clin Neuroradiol. 2022 Jun;32(2):353-360. doi: 10.1007/s00062-021-01048-8. Epub 2021 Jun 30. — View Citation

Hahn M, Groschel S, Hayani E, Brockmann MA, Muthuraman M, Groschel K, Uphaus T; German Stroke Registry-Endovascular Treatment (GSR-ET) Study Group. Sex Disparities in Re-Employment in Stroke Patients With Large Vessel Occlusion Undergoing Mechanical Thrombectomy. Stroke. 2022 Aug;53(8):2528-2537. doi: 10.1161/STROKEAHA.121.037386. Epub 2022 Apr 21. — View Citation

Hahn M, Groschel S, Tanyildizi Y, Brockmann MA, Groschel K, Uphaus T; German Stroke Registry-Endovascular Treatment (GSR-ET) Investigators. The Bigger the Better? Center Volume Dependent Effects on Procedural and Functional Outcome in Established Endovascular Stroke Centers. Front Neurol. 2022 Mar 2;13:828528. doi: 10.3389/fneur.2022.828528. eCollection 2022. — View Citation

Herzberg M, Scherling K, Stahl R, Tiedt S, Wollenweber FA, Kupper C, Feil K, Forbrig R, Patzig M, Kellert L, Kunz WG, Reidler P, Zimmermann H, Liebig T, Dieterich M, Dorn F; GSR investigators. Late Thrombectomy in Clinical Practice : Retrospective Application of DAWN/DEFUSE3 Criteria within the German Stroke Registry. Clin Neuroradiol. 2021 Sep;31(3):799-810. doi: 10.1007/s00062-021-01033-1. Epub 2021 Jun 7. — View Citation

Kellert L, Wollenweber FA, Thomalla G, Nolte CH, Fiehler J, Ringleb PA, Dorn F. Thrombolysis management in thrombectomy patients: Real-life data from German stroke centres. Eur Stroke J. 2017 Dec;2(4):356-360. doi: 10.1177/2396987317727229. Epub 2017 Aug 17. — View Citation

Kniep H, Bechstein M, Broocks G, Brekenfeld C, Flottmann F, van Horn N, Geest V, Faizy TD, Deb-Chatterji M, Alegiani A, Thomalla G, Gellissen S, Fiehler J, Hanning U, Meyer L; German Stroke Registry-Endovascular Treatment (GSR-ET). Early surrogates of outcome after thrombectomy in posterior circulation stroke. Eur J Neurol. 2022 Nov;29(11):3296-3306. doi: 10.1111/ene.15519. Epub 2022 Aug 28. — View Citation

Kniep H, Meyer L, Bechstein M, Broocks G, Guerreiro H, van Horn N, Brekenfeld C, Flottmann F, Deb-Chatterji M, Alegiani A, Thomalla G, Hanning U, Fiehler J, Gellissen S; GSR-ET (German Stroke Registry-Endovascular Treatment). How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge? Stroke. 2022 Sep;53(9):2828-2837. doi: 10.1161/STROKEAHA.121.037888. Epub 2022 May 13. — View Citation

Kupper C, Feil K, Wollenweber FA, Tiedt S, Herzberg M, Dorn F, Liebig T, Dieterich M, Kellert L; GSR investigators. Endovascular stroke treatment in orally anticoagulated patients: an analysis from the German Stroke Registry-Endovascular Treatment. J Neurol. 2021 May;268(5):1762-1769. doi: 10.1007/s00415-020-10369-6. Epub 2020 Dec 29. — View Citation

Leischner H, Brekenfeld C, Meyer L, Broocks G, Faizy T, McDonough R, Gerloff C, Thomalla G, Deb-Chatterji M, Fiehler J, Flottmann F; German Stroke Registry - Endovascular treatment (GSR) *. Study Criteria Applied to Real Life-A Multicenter Analysis of Stroke Patients Undergoing Endovascular Treatment in Clinical Practice. J Am Heart Assoc. 2021 Nov 16;10(22):e017919. doi: 10.1161/JAHA.120.017919. Epub 2021 Nov 15. — View Citation

Maros ME, Brekenfeld C, Broocks G, Leischner H, McDonough R, Deb-Chatterji M, Alegiani A, Thomalla G, Fiehler J, Flottmann F; GSR Investigators*. Number of Retrieval Attempts Rather Than Procedure Time Is Associated With Risk of Symptomatic Intracranial Hemorrhage. Stroke. 2021 May;52(5):1580-1588. doi: 10.1161/STROKEAHA.120.031242. Epub 2021 Apr 5. — View Citation

Meyer L, Alexandrou M, Flottmann F, Deb-Chatterji M, Abdullayev N, Maus V, Politi M, Bernkopf K, Roth C, Kastrup A, Hanning U, Brekenfeld C, Thomalla G, Gerloff C, Mpotsaris A, Papanagiotou P, Fiehler J, Leischner H; German Stroke Registry-Endovascular Treatment (GSR-ET) dagger. Endovascular Treatment of Very Elderly Patients Aged >/=90 With Acute Ischemic Stroke. J Am Heart Assoc. 2020 Mar 3;9(5):e014447. doi: 10.1161/JAHA.119.014447. Epub 2020 Feb 24. — View Citation

Meyer L, Bechstein M, Bester M, Hanning U, Brekenfeld C, Flottmann F, Kniep H, van Horn N, Deb-Chatterji M, Thomalla G, Sporns P, Yeo LL, Tan BY, Gopinathan A, Kastrup A, Politi M, Papanagiotou P, Kemmling A, Fiehler J, Broocks G; German Stroke Registry-Endovascular Treatment (GSR-ET). Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage. Stroke. 2021 Oct;52(10):3109-3117. doi: 10.1161/STROKEAHA.120.033101. Epub 2021 Sep 2. — View Citation

Meyer L, Broocks G, Bechstein M, Flottmann F, Leischner H, Brekenfeld C, Schon G, Deb-Chatterji M, Alegiani A, Thomalla G, Fiehler J, Kniep H, Hanning U; German Stroke Registry - Endovascular Treatment (GSR - ET). Early clinical surrogates for outcome prediction after stroke thrombectomy in daily clinical practice. J Neurol Neurosurg Psychiatry. 2020 Oct;91(10):1055-1059. doi: 10.1136/jnnp-2020-323742. — View Citation

Meyer L, Politi M, Alexandrou M, Roth C, Kastrup A, Mpotsaris A, Hanning U, Flottmann F, Brekenfeld C, Deb-Chatterji M, Thomalla G, Kniep H, Faizy TD, Bechstein M, Broocks G, Herzberg M, Feil K, Kellert L, Dorn F, Zelenak K, Fiehler J, Papanagiotou P; German Stroke Registry-Endovascular Treatment (GSR-ET); German Stroke Registry - Endovascular Treatment (GSR - ET). Endovascular treatment of acute tandem lesions in patients with mild anterior circulation stroke. J Neurointerv Surg. 2022 Aug 26:neurintsurg-2022-019239. doi: 10.1136/jnis-2022-019239. Online ahead of print. — View Citation

Quandt F, Flottmann F, Madai VI, Alegiani A, Kupper C, Kellert L, Hilbert A, Frey D, Liebig T, Fiehler J, Goyal M, Saver JL, Gerloff C, Thomalla G, Tiedt S; GSR investigators and the VISTA-Endovascular Collaborators. Machine Learning-Based Identification of Target Groups for Thrombectomy in Acute Stroke. Transl Stroke Res. 2022 Jun 7. doi: 10.1007/s12975-022-01040-5. Online ahead of print. — View Citation

Schaefer JH, Kurka N, Keil F, Wagner M, Steinmetz H, Pfeilschifter W, Bohmann FO. Endovascular treatment for ischemic stroke with the drip-and-ship model-Insights from the German Stroke Registry. Front Neurol. 2022 Aug 23;13:973095. doi: 10.3389/fneur.2022.973095. eCollection 2022. — View Citation

Schlemm L, von Rennenberg R, Siebert E, Bohner G, Flottmann F, Petzold GC, Thomalla G, Endres M, Nolte CH; GSR-ET investigators. Mechanical thrombectomy in patients with cervical artery dissection and stroke in the anterior or posterior circulation - a multicenter analysis from the German Stroke Registry. Neurol Res Pract. 2021 May 3;3(1):20. doi: 10.1186/s42466-021-00119-y. — View Citation

Stosser S, Bode FJ, Dorn F, Petzold GC; GSR-ET Study Group. Workflow Times and Outcome of Endovascular Therapy in Stroke Patients with Initial MRI or CT. Cerebrovasc Dis. 2022;51(1):45-51. doi: 10.1159/000517903. Epub 2021 Jul 30. — View Citation

Stosser S, Bode FJ, Meissner JN, Weller JM, Kindler C, Sauer M, Paech D, Riegler C, Nolte CH, Pourian A, Rother J, Selo N, Ernemann U, Poli S, Eckert RM, Bohner G, Scherling K, Dorn F, Petzold GC; GSR-ET study group. Outcome of Stroke Patients with Unknown Onset and Unknown Time Last Known Well Undergoing Endovascular Therapy. Clin Neuroradiol. 2022 Jul 7. doi: 10.1007/s00062-022-01188-5. Online ahead of print. — View Citation

Tiedt S, Bode FJ, Uphaus T, Alegiani A, Groschel K, Petzold GC; GSR-ET investigators. Impact of the COVID-19-pandemic on thrombectomy services in Germany. Neurol Res Pract. 2020 Nov 23;2:44. doi: 10.1186/s42466-020-00090-0. eCollection 2020. — View Citation

Tiedt S, Herzberg M, Kupper C, Feil K, Kellert L, Dorn F, Liebig T, Alegiani A, Dichgans M, Wollenweber FA; GSR Investigators. Stroke Etiology Modifies the Effect of Endovascular Treatment in Acute Stroke. Stroke. 2020 Mar;51(3):1014-1016. doi: 10.1161/STROKEAHA.119.028383. Epub 2019 Dec 18. — View Citation

Weller JM, Dorn F, Meissner JN, Stosser S, Beckonert NM, Nordsiek J, Kindler C, Deb-Chatterji M, Petzold GC, Bode FJ; GSR-ET investigators. Endovascular thrombectomy in young patients with stroke. Int J Stroke. 2022 Sep 7:17474930221119602. doi: 10.1177/17474930221119602. Online ahead of print. — View Citation

Weller JM, Dorn F, Meissner JN, Stosser S, Beckonert NM, Nordsiek J, Kindler C, Riegler C, Keil F, Petzold GC, Bode FJ; GSR-ET investigators. Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation. Neurol Res Pract. 2022 Sep 12;4(1):42. doi: 10.1186/s42466-022-00207-7. — View Citation

Weller JM, Enkirch SJ, Bogs C, Braemswig TB, Deb-Chatterji M, Keil F, Kindler C, Maywald S, Schirmer MD, Stosser S, Solymosi L, Nolte CH, Bode FJ, Petzold GC; GSR-ET Investigators. Endovascular Treatment for Acute Stroke in Cerebral Amyloid Angiopathy. Stroke. 2021 Oct;52(10):e581-e585. doi: 10.1161/STROKEAHA.120.033014. Epub 2021 Aug 20. — View Citation

Weller JM, Meissner JN, Stosser S, Dorn F, Petzold GC, Bode FJ; GSR-ET investigators. Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Concomitant Intracranial Hemorrhage. Clin Neuroradiol. 2022 Sep;32(3):809-816. doi: 10.1007/s00062-021-01128-9. Epub 2022 Jan 6. — View Citation

Wollenweber FA, Tiedt S, Alegiani A, Alber B, Bangard C, Berrouschot J, Bode FJ, Boeckh-Behrens T, Bohner G, Bormann A, Braun M, Dorn F, Eckert B, Flottmann F, Hamann GF, Henn KH, Herzberg M, Kastrup A, Kellert L, Kraemer C, Krause L, Lehm M, Liman J, Lowens S, Mpotsaris A, Papanagiotou P, Petersen M, Petzold GC, Pfeilschifter W, Psychogios MN, Reich A, von Rennenberg R, Rother J, Schafer JH, Siebert E, Siedow A, Solymosi L, Thonke S, Wagner M, Wunderlich S, Zweynert S, Nolte CH, Gerloff C, Thomalla G, Dichgans M, Fiehler J. Functional Outcome Following Stroke Thrombectomy in Clinical Practice. Stroke. 2019 Sep;50(9):2500-2506. doi: 10.1161/STROKEAHA.119.026005. Epub 2019 Jul 24. — View Citation

* Note: There are 40 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	modified Ranking Scale (mRS) on day 90	The scale is a commonly used measurement for the degree of disability or dependence in the daily activities of people who have suffered a stroke; scale range 0-6; with 0 - No symptoms. 1 - No significant disability. Able to carry out all usual activities, despite some symptoms. 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities. 3 - Moderate disability. Requires some help, but able to walk unassisted. 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted. 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent. 6 - Dead. publication: van Swieten J, Koudstaal P, Visser M, Schouten H, et al. (1988). "Interobserver agreement for the assessment of handicap in stroke patients". Stroke. 19 (5): 604-607. doi:10.1161/01.str.19.5.604. PMID 3363593.	90 days