Clinical multidimensional prediction model for futile reperfusion in acute ischemic stroke after endovascular thrombectomy

Abstract

Background Previous Studies on prediction models for futile reperfusion after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) related to large vessel occlusion (LVO) have yielded inconsistent results. This inconsistency may be largely attributed to methodological limitations, particularly in variable selection and missing data handling. Consequently, the prognostic value of several key clinical predictors remains to be fully elucidated. Methods This retrospective study included 390 patients with AIS who underwent EVT at Ningbo No.2 Hospital. All of them achieved successful reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) score ≥ 2b. Futile reperfusion was defined as a modified Rankin Scale score of 3–6 at 90-day. Missing data were handled with multiple imputation. Logistic regression models were built using a two step predictor selection process: first univariable screening with p < 0.2; then further selection based on event count constraints. Only variables that were selected in all five imputed datasets, meaning a 100% selection frequency, were retained. Model performance measures were pooled following Rubin’s rules. Results Based on preoperative assessments integrating clinical, imaging, and laboratory markers, the final model comprised nine variables: National Institutes of Health Stroke Scale (NIHSS) score, Computed Tomography angiography-source images Alberta Stroke Program Early Computed Tomography Score (CTA-SI ASPECTS), time from onset to reperfusion (OTR), collateral circulation scores (CCS), C-reactive protein (CRP), glucose, white blood cell (WBC) count, neutrophil count, and monocyte count. The final model demonstrated good discriminative ability, with a pooled test AUC of 0.795 and a Brier score of 0.178. At the optimal threshold (mean 0.457), the model achieved a specificity of 0.822 and accuracy of 0.761, with positive net benefit across clinically relevant threshold probabilities on decision curve analysis. A nomogram incorporating the nine consistently selected predictors was developed to facilitate individualized risk prediction. Conclusion We developed a multidimensional model integrating clinical, imaging, and laboratory markers to predict futile reperfusion following EVT in patients with anterior circulation stroke. Each marker provides independent prognostic information; collectively, they represent the multidimensional risk architecture underlying postprocedural outcomes.

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