Risk factors affecting the first pass effect in mechanical thrombectomy for acute ischemic stroke with anterior circulation large vessel occlusion and its nomogram prediction model
10.3760/cma.j.cn115396-20250312-00053
- VernacularTitle:机械取栓治疗前循环急性大血管闭塞缺血性卒中影响首过效应的风险因素及其列线图预测模型
- Author:
Chunsheng SANG
1
;
Jianren WANG
;
Xi′an FU
Author Information
1. 南京医科大学附属苏州医院（苏州市立医院）神经外科，苏州 215008
- Keywords:
Stroke;
Arterial occlusive diseases;
Nomograms;
Mechanical thrombectomy;
First-pass effect
- From:
International Journal of Surgery
2025;52(9):592-598
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To construct a nomogram model for predicting the first pass effect (FPE) in mechanical thrombectomy for acute ischemic stroke with anterior circulation large vessel occlusion(AIS-LVO).Methods:Retrospectively controlled analyzed the clinical data of 146 patients with acute ischemic stroke due to anterior circulation large vessel occlusion who underwent mechanical thrombectomy in the Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital) from January 2020 to January 2025. Among the 146 patients, there were 76 males and 70 females, with an age ranged from 39 to 88 years old and a median age of 75 years. According to whether FPE was obtained during the operation, the patients were divided into the FPE group ( n=47)and the non-FPE group ( n=99). The clinical data between the two groups were compared, and those with statistically significant differences ( P<0.05) throngh univariate analysis were included in the multivariate Logistic regression analysis to screen the independent risk factors affecting FPE and establish a nomogram model. The efficiency, goodness of fit and benefit of the established model were tested through internal validation. Results:The results of univariate analysis showed that there were statistically significant differences in the history of essential hypertension, clot burden score (CBS), internal carotid artery tortuosity, hyperdense vessel sign, serum D-dimer value, serum lymphocyte count, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) between the two groups ( P<0.05). Multivariate Logistic regression analysis showed that the history of essential hypertension ( OR=0.25, 95% CI: 0.09-0.67, P=0.006), high clot burden with CBS ≤ 6 points ( OR=0.25, 95% CI: 0.10-0.66, P=0.005), internal carotid artery tortuosity ( OR=0.38, 95% CI: 0.15-0.98, P=0.044), high PLR ( OR=0.98, 95% CI: 0.97-0.99, P=0.005), and high D-dimer ( OR=0.35, 95% CI: 0.15-0.81, P=0.015) were all independent risk factors affecting FPE in mechanical thrombectomy for acute ischemic stroke with anterior circulation large vessel occlusion ( P<0.05). A nomogram prediction model was established based on the above risk factors. The verification results showed that the area under the curve was 0.836, the Hosmer-Lemeshow test showed that χ2=5.105, P=0.746, and the decision curve showed that when the threshold probability was in the range of 0.01 to 0.87, there was a higher net benefit value. Conclusion:The nomogram model established according to the patient′s history of essential hypertension, clot burden score, whether there is internal carotid artery tortuosity, PLR, and D-dimer can predict the probability of obtaining FPE in mechanical thrombectomy for acute ischemic stroke with anterior circulation large vessel occlusion.
