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arXiv · 2511.02088

In silico trials of acute ischemic stroke: predicting the total potential for improvement to patient functional outcomes

Claire M. Miller·Raymond Padmos·Praneeta Konduri·Tamás István Józsa·Yidan Xue·Nerea Arrarte Terreros·Max van der Kolk·Stephen Payne·Henk Marquering·Charles Majoie Alfons Hoekstra
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Abstract

This study uses in silico trials (ISTs) to quantify the potential for benefit due to improved recanalisation outcomes and shorter time to treatment for acute ischaemic stroke (AIS) patients. We use an IST framework to run trials on cohorts of virtual patients with early and late treatment after stroke onset, and with successful (full) and unsuccessful (no) recanalisation outcomes. Using a virtual population of AIS patients, and in silico models of blood flow, perfusion, and tissue death, we predict the functional independence of each patient at 90 days using the modified Rankin Scale (mRS). Results predict 57% of the virtual population achieve functional independence with full recanalisation and a treatment time of 4 hours or less, compared to 29% with no recanalisation and more than 4 hours to treatment. Successful recanalisation was more beneficial than faster treatment: the best-case common odds ratio (improved mRS) due to recanalisation was 2.7 compared to 1.6 for early treatment. This study provides a proof-of-concept for a novel use-case of ISTs: quantifying the maximum potential for improvement to patient outcomes. This would be useful during early stages of therapy development, to determine the target populations and therapy goal with the greatest potential for population improvements.

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Claire M. Miller, Raymond Padmos, Praneeta Konduri, Tamás István Józsa, Yidan Xue, Nerea Arrarte Terreros, Max van der Kolk, Stephen Payne, Henk Marquering, Charles Majoie Alfons Hoekstra. 2025-11-03. In silico trials of acute ischemic stroke: predicting the total potential for improvement to patient functional outcomes. https://arxiv.org/abs/2511.02088

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