Background and Purpose: Acute ischemic stroke (AIS) is a serious threat to the life and health of middle-aged and elderly people. Mechanical thrombectomy offers the advantages of rapid recanalization, but the response of patients to this treatment varies greatly. This study investigated the risk factors for futile recanalization in AIS patients after thrombectomy through multivariate analyses. Methods: A retrospective study was conducted in AIS patients with anterior circulation occlusion from a derivation cohort and a validation cohort who underwent thrombectomy and reperfusion defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. Using the modified Rankin Scale (mRS) at 90 days after the operation, the patients were divided into two groups, the meaningful recanalization group (mRS ≤ 2), and the futile recanalization group (mRS > 2). Multivariate logistic regression analyses were performed, and the receiver operating characteristic (ROC) curve was used to construct a risk prediction model for futile recanalization. The performance of prediction model was evaluated on the validation cohort. Results: A total of 140 patients in the derivation cohort were enrolled, 46 patients in the meaningful recanalization group and 94 patients in the futile recanalization group. The two groups were significantly different in age, preoperative National Institute of Health Stroke Scale (NIHSS) score, and collateral circulation ASITN/SIR grade (P < 0.05). In multivariate regression analyses, patients' age ≥ 71, NIHSS ≥ 12, and ASITN/SIR ≤ 3 were risk factors for futile recanalization. Hence, an ANA (Age-NIHSS-ASITN/SIR) score scale consisting of age, NIHSS score, and ASITN/SIR grade factors can effectively predict the risk for futile recanalization (area under curve 0.75, 95% CI 0.67-0.83, specificity 67.4%, and sensitivity 73.4%). The proportion of patients with futile recanalization in ANA groups 0, 1, 2, and 3 were 21.05, 56.76, 79.03, and 90.91%, respectively. Furthermore, ANA score scale had also a good performance for predicting futile recanalization on the validation cohort. Conclusions: Old age, high baseline NIHSS, and poor collateral circulation are risk factors for futile recanalization in AIS patients treated with thrombectomy. An ANA score that considers age, NIHSS, and collateral ASITN/SIR can effectively predict the risk for futile recanalization. Further studies with a larger sample size are needed to validate the prognostic value of this combined score for futile recanalization.

中文翻译：

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机械取栓治疗急性缺血性中风患者无效再通的多因素分析。

背景与目的：急性缺血性脑卒中（AIS）是严重威胁中老年人生命和健康的疾病。机械取栓具有快速再通的优点，但患者对这种治疗的反应差异很大。本研究通过多变量分析调查了 AIS 患者血栓切除术后无效再通的危险因素。方法：对来自衍生队列和验证队列的前循环闭塞的 AIS 患者进行了一项回顾性研究，这些患者接受了血栓切除术和再灌注，定义为脑梗死的改良溶栓 (mTICI) 评分为 2b/3。术后90天采用改良Rankin量表（mRS）将患者分为两组，有意义再通组（mRS≤2），和无效再通组（mRS > 2）。进行多变量逻辑回归分析，并使用受试者工作特征（ROC）曲线构建无效再通风险预测模型。在验证队列中评估预测模型的性能。结果：推导队列共纳入140例患者，有意义再通组46例，无效再通组94例。两组在年龄、术前美国国立卫生研究院卒中量表（NIHSS）评分、侧支循环ASITN/SIR分级等方面存在显着差异（P < 0.05）。在多元回归分析中，患者年龄≥ 71、NIHSS ≥ 12 和 ASITN/SIR ≤ 3 是无效再通的危险因素。因此，由年龄、NIHSS 评分和 ASITN/SIR 分级因素组成的 ANA（Age-NIHSS-ASITN/SIR）评分量表可以有效预测无效再通的风险（曲线下面积 0.75，95% CI 0.67-0.83，特异性 67.4% ，灵敏度为 73.4%）。ANA 0、1、2、3组无效再通患者比例分别为21.05、56.76、79.03、90.91%。此外，ANA 评分量表在预测验证队列中的无效再通方面也有良好的表现。结论：高龄、高基线 NIHSS 和侧支循环不良是接受血栓切除术治疗的 AIS 患者无效再通的危险因素。考虑年龄、NIHSS 和附属 ASITN/SIR 的 ANA 评分可以有效预测无效再通的风险。