Abstract:

Objective

To investigate the predictive value of preoperative CTA-based clot burden score for the first pass effect （FPE） of stent retrieve thrombectomy for acute anterior circulation large vessel occlusion.

Methods

The clinical data of 395 consecutive acute ischemic stroke （AIS） patients treated with first-line stent retrieve thrombectomy for large vessel occlusion in the anterior circulation at the First Affiliated Hospital of Nanjing Medical University from January 2021 to December 2023 were retrospectively included. Patients were divided into the FPE group （114 cases） and the non-FPE group （281 cases） according to angiography after the first thrombectomy attempt. Univariate and multivariate logistic regression analyses were used to identify predictors of FPE. The overall discriminative ability of clot burden score in predicting FPE was evaluated by receiver operating characteristic （ROC） curve.

Results

After adjustment for potential confounders， clot burden score （OR： 2.454， 95%CI： 1.753～3.429， P＜0.001） remained as an independent predictor for FPE. Based on the ROC， the clot burden score as a predictor for predicting FPE had an area under the curve of 0.820. The optimized cut-off of the clot burden score for predicting FPE was 6. When the score was ≥ 6， the sensitivity for predicting FPE was 87.3%， the specificity was 76.9%， the positive predictive value was 79.1%， and the negative predictive value was 91.4%.

Conclusion

The clot burden score had predictive value for FPE of stent retrieve thrombectomy for acute anterior circulation large vessel occlusion and may be used as an early independent predictor of FPE.

Key words: Cclot burden score, Stroke, Tthrombectomy, First pass effect, Predict