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. 2022 Dec;32(4):987-995.
doi: 10.1007/s00062-022-01166-x. Epub 2022 May 9.

Full Reperfusion Without Functional Independence After Mechanical Thrombectomy in the Anterior Circulation : Performance of Prediction Models Before Versus After Treatment Initiation

Charlotte S Weyland  1 , Johannes A Vey  2 , Yahia Mokli  3   4 , Manuel Feisst  2 , Meinhard Kieser  2 , Christian Herweh  1 , Silvia Schönenberge  3 , Markus A Möhlenbruch  1 , Martin Bendszus  1 , Peter A Ringleb  3 , Simon Nagel  5
Affiliations

Full Reperfusion Without Functional Independence After Mechanical Thrombectomy in the Anterior Circulation : Performance of Prediction Models Before Versus After Treatment Initiation

Charlotte S Weyland et al. Clin Neuroradiol. 2022 Dec.

Abstract

Background and purpose: Prediction of futile recanalization (FR), i.e. failure of long-term functional independence despite full reperfusion in mechanical thrombectomy (MT), is instrumental in patients undergoing endovascular therapy.

Methods: Retrospective single-center analysis of patients treated for anterior circulation LVO ensuing successful MT (mTICI 2c-3) between January 2014 and April 2019. FR was defined as modified Rankin Scale (mRS) 90 days after stroke onset > 2 or mRS > pre-stroke mRS. Multivariable analysis was performed with variables available before treatment initiation regarding their association with FR. Performance of the regression model was then compared with a model including parameters available after MT.

Results: Successful MT was experienced by 549/1146 patients in total. FR occurred in 262/549 (47.7%) patients. Independent predictors of FR were male sex, odds ratio (OR) with 95% confidence interval (CI) 1.98 (1.31-3.05, p 0.001), age (OR 1.05, CI 1.03-1.07, p < 0.001), NIHSS on admission (OR 1.10, CI 1.06-1.13, p < 0.001), pre-stroke mRS (OR 1.22, CI 1.03-1.46, p 0.025), neutrophile-lymphocyte ratio (OR 1.03, CI 1.00-1.06, p 0.022), baseline ASPECTS (OR 0.77, CI 0.68-0.88, p < 0.001), and absence of bridging i.v. lysis (OR 1.62, 1.09-2.42, p 0.016). The prediction model's Area Under the Curve was 0.78 (CI 0.74-0.82) and increased with parameters available after MT to 0.86 (CI 0.83-0.89) with failure of early neurological improvement being the most important predictor of FR (OR 15.0, CI 7.2-33.8).

Conclusion: A variety of preinterventional factors may predict FR with substantial certainty, but the prediction model can still be improved by considering parameters only available after MT, in particular early neurological improvement.

Keywords: Early neurological improvement; Futile recanalization; Ischemic stroke; Logistic regression models; Outcome prediction.

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Conflict of interest statement

All authors declare that there is no conflict of interest related to the submitted study and manuscript. Disclosures: C. S. Weyland—none. J. A. Vey—none. Y. Mokli—none. M. Feisst—none. M. Kieser—none. C. Herweh—UNRELATED: Consultancy: Brainomix, Oxford, UK. S. Schönenberger—none. M. Bendszus—UNRELATED: Grants from Siemens, grants and personal fees from Novartis, grants from Stryker, grants from DFG, personal fees from Merck, personal fees from Bayer, personal fees from Teva, grants and personal fees from Guerbet, personalfees from Boehringer, personal fees from Vascular Dynamics, personal fees from Grifols, and grants from European Union, all outside the submitted work. M. A. Möhlenbruch—UNRELATED: Board Membership: Codman; Consultancy: Medtronic, MicroVention, Stryker; Payment for Lectures Including Service on Speakers Bureaus: Medtronic, MicroVention, Stryker. *Money paid to the institution. P. A. Ringleb—UNRELATED: Consultancy: Boehringer, Lecture fees from Bayer, Boehringer Ingelheim, BMS, Daichii Sankyo, Pfizer. S. Nagel—UNRELATED: Consultancy: Brainomix, Boehringer Ingelheim; Payment for Lectures Including Service on Speakers Bureaus: Pfizer, Medtronic, Bayer AG.

Figures

Fig. 1
Fig. 1
Receiver operating characteristic (ROC) curves for the prediction of futile recanalization after acute ischemic stroke considering only variables known before mechanical thrombectomy (a) and variables known after mechanical thrombectomy (b)
See this image and copyright information in PMC

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