Development of a nomogram prediction model for futile recanalization after endovascular therapy in patients with acute basilar artery occlusion / 国际脑血管病杂志

ABSTRACT

Objective:To develop a nomogram model for early prediction of the risk of futile recanalization after endovascular therapy (EVT) in patients with acute basilar artery occlusion (ABAO).Methods:Patients with ABAO who underwent EVT and achieved successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grade ≥2b) at the First Affiliated Hospital of Soochow University from January 2017 to September 2022 were retrospectively included. According to modified Rankin Scale score at 90 days after onset, they were categorized into effective recanalization group (0-3) and futile recanalization group (4-6). Univariate analysis and mutivariate logistic regression analysis were used to identify independent risk factors for futile recanalization. A nomogram prediction model was then developed based on the independent risk factors. The model’s discrimination, calibration, and clinical utility were evaluated using receiver operator characteristic (ROC) curves, calibration curves, and clinical decision curves, respectively. Results:A total of 83 patients were included. Their age was 64.2±11.8 years, and 58 were male (69.9%). The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 20 (interquartile range, 12-26). Forty patients (48.2%) experienced futile recanalization. The multivariate logistic regression analysis showed that the Basilar Artery on Computed Tomography Angiography (BATMAN) score at admission, failure to achieve first-pass effect during EVT, NIHSS score at 24 h after EVT, and neutrophil-to-lymphocyte ratio (NLR) within 24 h after EVT were the independent risk factors for futile recanalization (all P<0.05). The area under the ROC curve for the nomogram model developed from these four risk factors was 0.898 (95% confidence interval 0.831-0.964), with a predictive sensitivity of 75.0% and specificity of 90.7%. The calibration curve of this model was close to the ideal curve. The decision curve analysis showed that the model also had significant clinical net benefits. Conclusions:The nomogram model developed from BATMAN score at admission, first-pass effect, NIHSS score at 24 h after EVT, and NLR within 24 h after EVT has good predictive ability and clinical practicality, and can early predict futile recanalization in patients with ABAO at 1 day after EVT.