A visualized nomogram to online predict futile recanalization after endovascular thrombectomy in basilar artery occlusion stroke

Abstract

Background and purposeFutile recanalization occurs in a significant proportion of patients with basilar artery occlusion (BAO) after endovascular thrombectomy (EVT). Therefore, our goal was to develop a visualized nomogram model to early identify patients with BAO who would be at high risk of futile recanalization, more importantly, to aid neurologists in selecting the most appropriate candidates for EVT.MethodsPatients with BAO with EVT and the Thrombolysis in Cerebral Infarction score of ≥2b were included in the National Advanced Stroke Center of Nanjing First Hospital (China) from October 2016 to June 2021. The exclusion criteria were lacking the 3-month Modified Rankin Scale (mRS), age <18 years, the premorbid mRS score >2, and unavailable baseline CT imaging. Potential predictors were selected for the construction of the nomogram model and the predictive and calibration capabilities of the model were assessed.ResultsA total of 84 patients with BAO were finally enrolled in this study, and patients with futile recanalization accounted for 50.0% (42). The area under the curve (AUC) of the nomogram model was 0.866 (95% CI, 0.786–0.946). The mean squared error, an indicator of the calibration ability of our prediction model, was 0.025. A web-based nomogram model for broader and easier access by clinicians is available online at https://trend.shinyapps.io/DynNomapp/.ConclusionWe constructed a visualized nomogram model to accurately and online predict the risk of futile recanalization for patients with BAO, as well as assist in the selection of appropriate candidates for EVT.

Futile Recanalization After Endovascular Treatment in Patients With Acute Basilar Artery Occlusion

“…4 Regarding factors associated with futile recanalization, our study further confirmed that diabetes mellitus, baseline NIHSS score, baseline pc-ASPECTS score, and PC-CS score were predictors of futile recanalization, which is in line with previous studies. 15-19 We also showed that higher NLR values, PTR time, and incomplete reperfusion were associated with futile recanalization. What's more, multiple stent retriever passes were associated with a high proportion of futile recanalization in patients with late time windows.…”

“…[IQR], 63 [54-71] years vs 65 [58-74] years; P = .02), had a higher systolic blood pressure on admission (median[IQR], 146 mm Hg vs 151 [135-169] mm Hg; P = .03), higher neutrophil-to-lymphocyte ratio (NLR) (median [IQR], 6.3 [4.1-10.2] vs 9.2[5.8-13.4]; P < .001), higher baseline NIHSS score (median [IQR], 18[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] vs 30[21][22][23][24][25][26][27][28][29][30][31][32][33][34]; P < .001), lower baseline pc-ASPECTS score (median [IQR], 9[8][9][10] vs 8[6][7][8][9]; P < .001), lower PC-CS score (median [IQR], 5[4][5][6] vs 4 [3-6]; P < .001), and longer puncture to recanalization time (PTR) (median [IQR], 87 [62-128] minutes vs 110 [11-155] minutes; P < .001). In addition, the proportions of patients with diabetes mellitus (87 of 328 patients [26.5%] vs 21 of 194 patients [16.0%]; P = .005), coronary heart disease (59 of 328 patients [18.0%] vs 21 of 194 patients [10.8%]; P = .03), and symptomatic intracranial hemorrhage (24 of 328 patients [7.4%] vs 3 of 194 patients [1.5%]; P = .004) in the futile recanalization group were higher than those in the meaningful recanalization group.…”

A novel nomogram to predict futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy

“…Our nomogram incorporated variables, including age, preoperative SBP, OTR, and 24 h ICH, and showed good discriminatory ability, Nomograms are highly reliable and practical estimation tools that help predict prognosis and enhance clinical decisions on personalized treatment by combining different prognostic and determinant data and evaluating them in combination with several powerful event indicators (9)(10)(11). They are also widely used to predict the prognosis of stroke, including FR (6,12). Based on radiomics and with the help of machine learning, Yuqi Luo et al established nomogram to predict FR, focusing on the use of machine learning methods to integrate clinical information and imaging information, which is complex and limits its extensional generalizability (5).…”

“…The studies were included if they met the following criteria: (1) Aged ≥18 years old; (2) AIS: within 8 h; (3) baseline admission National Institute of Health Stroke Scale (NIHSS) score ≥ 6；(4) modified Rankin Scale (mRS) score before onset ≤ 2; (5) angiography confirmed intracranial internal carotid artery, middle cerebral artery (MCA) trunk acute obstruction in patients; (6) The subject (or his guardian) agreed to participate in the study and signed an informed consent form.…”

“…Some AIS patients could not achieve functional independence after successful MT therapy was named as futile recanalization (FR). Many studies (2,(4)(5)(6) are committed to building FR risk prediction models for acute LVOS patients after MT, but most of them are single-sample and retrospective studies, and there is still a lack of prospective, multicenter, and randomized studies in clinical practice.…”