Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion

BACKGROUND: Among patients with stroke eligible for endovascular treatment, preprocedure identification of those with low chances of successful recanalization with conventional devices (stent-retrievers and/or direct aspiration) may allow anticipating procedural rescue strategies. We aimed to develo...

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Autores: Flores, A, Elizalde, M, Seró, L, Ustrell, X, Avivar, Y, Pellisé, A, Rodriguez, P, Monterde, A, Lara, L, Gonzalez-de-Echavarri, JM, Cuba, V, Gisbert, MR, Requena, M, Molina, CA, Chamorro, A, de la Ossa, NP, Cardona, P, Cánovas, D, Purroy, F, Silva, Y, Camzpello, A, Marti-Fabregas, J, Abilleira, S, Ribó, M
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Institut d'Investigació i Innovació Parc Taulí (I3PT)
Repositorio:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
OAI Identifier:oai:i3pt.fundanetsuite.com:p5037
Acceso en línea:https://i3pt.portalinvestigacion.com/publicaciones/5037
Access Level:acceso abierto
Palabra clave:acute stroke
endovascular procedure
prognosis
recanalization
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spelling Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel OcclusionFlores, AElizalde, MSeró, LUstrell, XAvivar, YPellisé, ARodriguez, PMonterde, ALara, LGonzalez-de-Echavarri, JMCuba, VGisbert, MRRequena, MMolina, CAChamorro, Ade la Ossa, NPCardona, PCánovas, DPurroy, FSilva, YCamzpello, AMarti-Fabregas, JAbilleira, SRibó, Macute strokeendovascular procedureprognosisrecanalizationBACKGROUND: Among patients with stroke eligible for endovascular treatment, preprocedure identification of those with low chances of successful recanalization with conventional devices (stent-retrievers and/or direct aspiration) may allow anticipating procedural rescue strategies. We aimed to develop a preprocedural algorithm able to predict recanalization failure with conventional devices (RFCD). METHODS: Observational study. Data from consecutive patients with stroke who received endovascular treatment between 2019 and 2022 in 10 centers were collected from the Catalan Stroke Registry (Codi Ictus Catalunya Registry, CICAT). RFCD was defined as final thrombolysis in cerebral infarction <= 2a or the use of rescue therapy defined as balloon angioplasty +/- stent deployment. Univariate and multivariate analysis to identify variables associated with RFCD were performed. A gradient boosted decision tree machine learning model to predict RFCD was developed utilizing preprocedure variables previously selected. Clinical improvement at 24 hours was defined as a drop of >= 4 points from baseline National Institutes of Health Stroke Scale score or 0-1 at 24 hours. RESULTS: In total, 984 patients were included; RFCD was observed in 14.3% (n:141) of the cases. Of these, 47.5% (n = 67) received balloon angioplasty +/- stent deployment as rescue therapy. Among patients receiving balloon angioplasty +/- stent deployment, clinical improvement was associated with lower number of attempts with conventional devices (median number of passes 2 versus 3; P = 0.045). In logistic regression, the absence of atrial fibrillation (odds ratio [OR]: 2.730, 95%CI: 1.541-4.836; P = 0.007) and no-thrombolytic treatment (OR: 1.826, 95%CI: 1.230-2.711; P = 0.003) emerged as independent predictors of RFCD. A predictive model for RFCD, based on age, sex, hypertension, wake-up stroke, baseline National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT [Computed Tomography] Score, occlusion site, thrombolysis, and atrial fibrillation showed an acceptable discrimination (area under the curve: 0.72 +/- 0.024 SD) and accuracy (0.75 +/- 0.015 SD). Overall performance was moderate (weighted F1-score: 0.77 +/- 0.041 SD). CONCLUSION: In RFCD patients, early balloon angioplasty +/- stent deployment rescue was associated with improved outcomes. A predictive model using affordable preprocedure clinical variables could be useful to identify these patients before intervention.LIPPINCOTT WILLIAMS & WILKINS2024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://i3pt.portalinvestigacion.com/publicaciones/5037Stroke-Vascular and Interventional NeurologyISSN: 26945746reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulíinstname:Institut d'Investigació i Innovació Parc Taulí (I3PT)Inglésinfo:eu-repo/semantics/openAccessoai:i3pt.fundanetsuite.com:p50372026-06-21T15:30:37Z
dc.title.none.fl_str_mv Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion
title Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion
spellingShingle Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion
Flores, A
acute stroke
endovascular procedure
prognosis
recanalization
title_short Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion
title_full Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion
title_fullStr Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion
title_full_unstemmed Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion
title_sort Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion
dc.creator.none.fl_str_mv Flores, A
Elizalde, M
Seró, L
Ustrell, X
Avivar, Y
Pellisé, A
Rodriguez, P
Monterde, A
Lara, L
Gonzalez-de-Echavarri, JM
Cuba, V
Gisbert, MR
Requena, M
Molina, CA
Chamorro, A
de la Ossa, NP
Cardona, P
Cánovas, D
Purroy, F
Silva, Y
Camzpello, A
Marti-Fabregas, J
Abilleira, S
Ribó, M
author Flores, A
author_facet Flores, A
Elizalde, M
Seró, L
Ustrell, X
Avivar, Y
Pellisé, A
Rodriguez, P
Monterde, A
Lara, L
Gonzalez-de-Echavarri, JM
Cuba, V
Gisbert, MR
Requena, M
Molina, CA
Chamorro, A
de la Ossa, NP
Cardona, P
Cánovas, D
Purroy, F
Silva, Y
Camzpello, A
Marti-Fabregas, J
Abilleira, S
Ribó, M
author_role author
author2 Elizalde, M
Seró, L
Ustrell, X
Avivar, Y
Pellisé, A
Rodriguez, P
Monterde, A
Lara, L
Gonzalez-de-Echavarri, JM
Cuba, V
Gisbert, MR
Requena, M
Molina, CA
Chamorro, A
de la Ossa, NP
Cardona, P
Cánovas, D
Purroy, F
Silva, Y
Camzpello, A
Marti-Fabregas, J
Abilleira, S
Ribó, M
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv acute stroke
endovascular procedure
prognosis
recanalization
topic acute stroke
endovascular procedure
prognosis
recanalization
description BACKGROUND: Among patients with stroke eligible for endovascular treatment, preprocedure identification of those with low chances of successful recanalization with conventional devices (stent-retrievers and/or direct aspiration) may allow anticipating procedural rescue strategies. We aimed to develop a preprocedural algorithm able to predict recanalization failure with conventional devices (RFCD). METHODS: Observational study. Data from consecutive patients with stroke who received endovascular treatment between 2019 and 2022 in 10 centers were collected from the Catalan Stroke Registry (Codi Ictus Catalunya Registry, CICAT). RFCD was defined as final thrombolysis in cerebral infarction <= 2a or the use of rescue therapy defined as balloon angioplasty +/- stent deployment. Univariate and multivariate analysis to identify variables associated with RFCD were performed. A gradient boosted decision tree machine learning model to predict RFCD was developed utilizing preprocedure variables previously selected. Clinical improvement at 24 hours was defined as a drop of >= 4 points from baseline National Institutes of Health Stroke Scale score or 0-1 at 24 hours. RESULTS: In total, 984 patients were included; RFCD was observed in 14.3% (n:141) of the cases. Of these, 47.5% (n = 67) received balloon angioplasty +/- stent deployment as rescue therapy. Among patients receiving balloon angioplasty +/- stent deployment, clinical improvement was associated with lower number of attempts with conventional devices (median number of passes 2 versus 3; P = 0.045). In logistic regression, the absence of atrial fibrillation (odds ratio [OR]: 2.730, 95%CI: 1.541-4.836; P = 0.007) and no-thrombolytic treatment (OR: 1.826, 95%CI: 1.230-2.711; P = 0.003) emerged as independent predictors of RFCD. A predictive model for RFCD, based on age, sex, hypertension, wake-up stroke, baseline National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT [Computed Tomography] Score, occlusion site, thrombolysis, and atrial fibrillation showed an acceptable discrimination (area under the curve: 0.72 +/- 0.024 SD) and accuracy (0.75 +/- 0.015 SD). Overall performance was moderate (weighted F1-score: 0.77 +/- 0.041 SD). CONCLUSION: In RFCD patients, early balloon angioplasty +/- stent deployment rescue was associated with improved outcomes. A predictive model using affordable preprocedure clinical variables could be useful to identify these patients before intervention.
publishDate 2024
dc.date.none.fl_str_mv 2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://i3pt.portalinvestigacion.com/publicaciones/5037
url https://i3pt.portalinvestigacion.com/publicaciones/5037
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
dc.source.none.fl_str_mv Stroke-Vascular and Interventional Neurology
ISSN: 26945746
reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
instname:Institut d'Investigació i Innovació Parc Taulí (I3PT)
instname_str Institut d'Investigació i Innovació Parc Taulí (I3PT)
reponame_str r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
collection r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
repository.name.fl_str_mv
repository.mail.fl_str_mv
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