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

Cheng-Cai Lai; Yin-Dan Yao; Xia Li; Ao-Fei Liu; Chen Li; Yun-E Liu; Chang-Chun Jiang; Ying-Ying Zhang; Min Jin; Jin Lv; Wei-Jian Jiang

doi:10.3389/fneur.2024.1367950

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

Front Neurol. 2024 Mar 22:15:1367950. doi: 10.3389/fneur.2024.1367950. eCollection 2024.

Authors

Cheng-Cai Lai^#^{1

2}, Yin-Dan Yao^#³, Xia Li^{1

4

5

6}, Ao-Fei Liu¹, Chen Li¹, Yun-E Liu¹, Chang-Chun Jiang^{4

5

6}, Ying-Ying Zhang¹, Min Jin¹, Jin Lv¹, Wei-Jian Jiang¹

Affiliations

¹ The PLA Rocket Force Characteristic Medical Center, Beijing, China.
² Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China.
³ Department of Neurology, Ningbo No.2 Hospital, Ningbo, Zhejiang, China.
⁴ Department of Neurology, Baotou Center Hospital, Baotou, China.
⁵ Neurointerventional Medical Center of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China.
⁶ Institute of Cerebrovascular Disease in Inner Mongolia, Hohhot, Inner Mongolia, China.

^# Contributed equally.

Abstract

Background and objective: Futile recanalization (FR) is defined as patients with acute ischemic stroke (AIS) due to large vessel occlusion who still exhibits functional dependence although undergoing successful mechanical thrombectomy (MT). We aimed to develop and validate a simple nomogram for predicting the probability of FR after MT treatment in AIS patients.

Methods: Clinical data of AIS patients in the Jrecan clinical trial in China from March 2018 to June 2019 were collected as the derivation set (n = 162). Meanwhile, clinical data of AIS patients who underwent MT in Baotou Central Hospital and Ningbo No.2 Hospital from 2019 to 2021 were collected as the validation set (n = 170). Multivariate logistic regression analysis was performed for all variables that had p < 0.2 in the univariate analysis in the derivation set. The independent risk factors of FR were further screened out and a nomogram was constructed. The performance of the nomogram was analyzed in the derivation and validation set using C-index, calibration plots, and decision curves.

Results: No significant difference in FR rate was detected between the derivation set and the validation set [88/162 (54.32%) and 82/170 (48.23%), p = 0.267]. Multivariate logistic regression analysis showed that age ≥ 65 years old (OR = 2.096, 95%CI 1.024-4.289, p = 0.043), systolic blood pressure (SBP) ≥ 180 mmHg (OR = 5.624, 95%CI 1.141-27.717, p = 0.034), onset to recanalization time (OTR) ≥ 453 min (OR = 2.759, 95%CI 1.323-5.754, p = 0.007), 24 h intracerebral hemorrhage (ICH; OR = 4.029, 95%CI 1.844 ~ 8.803, p < 0.001) were independent risk factors for FR. The C-index of the nomogram of the derivation set and the verification set were 0.739 (95%CI 0.662~0.816) and 0.703 (95%CI 0.621~0.785), respectively.

Conclusion: The nomogram composed of age, SBP, OTR, and 24 h ICH can effectively predict the probability of FR after MT in AIS patients.

Keywords: acute ischemic stroke; futile recanalization; mechanical thrombectomy; nomogram; predict.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the grants from National Key Basic Research Program of China (973 program) (grant no. 2013CB733805), and the National Natural Science Foundation of China (grant no. 81871464).