Risk factors and nomogram prediction model for futile recanalization after endovascular mechanical thrombectomy beyond 24 hours from last known well in patients with anterior circulation large vessel occlusion stroke
10.3760/cma.j.issn.1673-4165.2025.05.001
- VernacularTitle:发病时间超过24 h的前循环大血管闭塞性卒中患者血管内机械血栓切除术后无效再通的危险因素和列线图预测模型
- Author:
Chao HOU
1
;
Ruidong YE
;
Gelin XU
Author Information
1. 南京大学医学院附属金陵医院神经内科，南京 210002
- Keywords:
Ischemic stroke;
Endovascular procedures;
Thrombectomy;
Treatment outcome;
Risk factors;
Time factor
- From:
International Journal of Cerebrovascular Diseases
2025;33(5):321-328
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the risk factors for futile recanalization after endovascular mechanical thrombectomy (EMT) beyond 24 hours from last known well in patients with anterior circulation large vessel occlusion stroke, and develop a nomogram prediction model.Methods:Patients with anterior circulation large vessel occlusion stroke underwent EMT beyond 24 hours from last known well in the China Interventional Stroke Registry (CISR) database from May 2016 to September 2023 were included retrospectively. Futile recanalization was defined as successful vascular recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b), but the modified Rankin Scale score was >2 at 3 months after procedure. Independent predictive factors for futile recanalization were screened through stepwise multivariate logistic regression analysis and a nomogram prediction model was developed based on these factors, and the predictive value of the nomogram model was evaluated through receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Results:A total of 98 patients with anterior circulation large vessel occlusion stroke underwent EMT and achieved successful recanalization beyond 24 hours from last known well were included. There were 80 males (81.63%), with a median age of 63 (interquartile range, 52-69) years, and 44 patients (44.90%) had futile recanalization. Univariate analysis showed that the age, baseline National Institutes of Health Stroke Scale (NIHSS) score, and fasting blood glucose of the futile reperfusion group were significantly higher than those of the effective reperfusion group, while the Alberta Stroke Program Early CT Score (ASPECTS) and the proportion of patients with good collateral circulation were significantly lower than those of the effective reperfusion group (all P<0.05). Stepwise multivariate logistic regression analysis showed that higher age, blood glucose and baseline NIHSS score, lower collateral circulation score and ASPECTS were the independent predictive factors of futile recanalization. ROC curve analysis shows that the area under the curve of the nomogram model developed based on the above predictive factors was 0.84 (95% confidence interval 0.79-0.94). Further internal validation using bootstrap method with 1 000 repeated samples showed that the area under the curve was still as high as 0.83 (95% confidence interval 0.76-0.90). The calibration curve and clinical decision curve showed that this prediction model had good calibration accuracy and clinical net benefit. Conclusions:Patients with anterior circulation large vessel occlusion stroke beyond 24 hours from last known well have a higher risk of futile recanalization after undergoing EMT. Advanced age, higher blood sugar level, more serious baseline neurological deficits, larger infarct volume, and poorer collateral circulation are significantly associated with the futile recanalization. The nomogram developed based on the above factors provides a quantitative tool for predicting the risk of futile recanalization before procedures.
