The CHA2DS2-VASc risk score predicts futile recanalization after endovascular treatment in patients with acute ischemic stroke

Abstract

Objective: This study aimed to evaluate the utility of the CHA2DS2-VASc score for predicting futile recanalization among patients with acute ischemic stroke (AIS) who underwent endovascular treatment (EVT). Methods: A total of 97 AIS patients who achieved complete or near-complete recanalization after EVT were included in our study. Clinical, angiographic, and laboratory data were analyzed retrospectively. Using the modified Rankin Scale (mRS) at 90 days after the intervention, the patients were divided into two groups, the futile recanalization group (mRS ≥3) and the favorable recanalization group (mRS ≤2). The receiver-operating characteristics (ROC) curve was used to determine the cut-off value of the CHA2DS2-VASc score for predicting futile recanalization.Multivariate stepwise logistic regression analysis analyzed the association between the CHA2DS2-VASc score and futile recanalization risk after EVT. Results: The CHA2DS2-VASc score was significantly higher in patients with futile recanalization compared to patients with favorable recanalization [4 (3-6) vs. 3 (1-4), p=0.002]. A ROC curve analysis revealed that the cut-off value of CHA2DS2-VASc score for predicting futile recanalization was >3, with sensitivity and specificity of 65% and 72%, respectively (Area under curve (AUC), 0.697; 95% Confidence interval (CI):0.580-0.814). In multivariate analysis;the CHA2DS2- VASc score (Odds ratio (OR)=1.637, 95% CI:1.181-2.334, p=0.004) and baseline National Institutes of Health Stroke Scale score (OR=1.217, 95% CI:0.985-1.503, p=0.039) were found independent predictors for futile recanalization after EVT. Conclusion: The CHA2DS2-VASc score can be used as a simple and effective tool to predict futile recanalization in patients with AIS.

Comprehensive Meta-Analysis of Futile Recanalization in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy: Prevalence, Factors, and Clinical Outcomes

“…A comprehensive analysis of thirty-nine studies [8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]51], comprising a total of 11,700 patients, was conducted to assess the pooled prevalence of FR in AIS patients (Figure 2). The meta-analysis revealed an estimated pooled prevalence of 51%, with a range between 48% and 54% (ES 51%; 95% CI 48-54%; z = 47.66; p < 0.001) (Table 2 and Figure 2).…”

“…Twenty-two studies [11,15,17,19,[21][22][23][24][25]28,[30][31][32][33][34]39,40,[42][43][44][45]51], with a cumulative cohort of 5455 patients, examined the pooled prevalence of FR in AIS patients through retrospective studies (Figure 2). The meta-analysis indicated an estimated pooled prevalence of 51%, with a range from 46% to 56% (ES 51%; 95% CI 46-56%; z = 31.07; p < 0.001) (Table 4).…”

“…Two studies [31,42], with a cohort size of 144 reported on the prevalence of FR in AIS patients undergoing EVT in the Middle East. However, a meta-analysis was unable to be performed due to an insufficient number of studies (Table 4).…”

“…The association between CVD and FR was assessed in 17 studies, involving 2610 patients [16,20,21,24,25,28,32,33,36,38,[40][41][42][43][44][45][46][47]. The overall analysis showed that CVD was not significantly associated with an increased risk of FR (OR 1.152, 95% CI: [0.795; 1.671], p = 0.454).…”

“…In a meta-analysis comprising 33 studies with a total of 9438 patients, HTN was significantly associated with an increased likelihood of FR (OR 1.648, 95% CI: [1.412; 1.924], p < 0.001) [8,12,13,[15][16][17][18][19][20][21][22][24][25][26][28][29][30][32][33][34]36,[38][39][40][41][42][43][44][45][46][47][48]51]. The association between HTN and FR was consistent in patients with anterior circulation occlusions and across prospective and retrospective study designs.…”