Factors Influencing Poor Prognosis After Endovascular Thrombectomy for Acute Ischemic Stroke of Anterior Circulation Large Vessel Occlusion and Construction of a Risk Prediction Model

doi:10.3877/cma.j.issn.2095-5782.2026.03.010

Abstract

Abstract:

Objective

To explore the influencing factors of poor prognosis after mechanical thrombectomy for anterior circulation stroke and to construct prediction model.

Methods

Patients with anterior circulation ALVOS who underwent mechanical thrombectomy from January 2020 to December 2024 were divided into good prognosis group and poor prognosis group based on the 90-day postoperative prognosis. The baseline data, surgical conditions, and perioperative complications were analyzed. A clinical prediction model was constructed and its accuracy and efficacy were verified.

Results

A total of 528 patients were enrolled. Logistic regression analysis indicated that age, time of consultation, D-dimer, NIHSS score, number of thrombectomy, symptomatic intracranial hemorrhage, and successful reperfusion were independent influencing factors for poor prognosis (P< 0.05). Based on the above factors, a prediction model was constructed, and the calibration curve and decision curve showed that the model had good efficacy.

Conclusion

The model constructed for anterior circulation ALVOS based on age, time of consultation, D-dimer, baseline NIHSS score, number of thrombectomy, successful reperfusion, and symptomatic intracranial hemorrhage has good predictive efficacy for poor prognosis.

Key words: Acute large vessel occlusive stroke, Poor prognosis, Prediction model

Jingjing Zhang, Fayong Zhu, Ya Liu, Xiaohu Pan, Xuesong Shi, Minggang Yang, Chunming Xie, Guofeng Zhao. Factors Influencing Poor Prognosis After Endovascular Thrombectomy for Acute Ischemic Stroke of Anterior Circulation Large Vessel Occlusion and Construction of a Risk Prediction Model[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(03): 292-298.

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URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2026.03.010

https://zhjrfsxdzzz.cma-cmc.com.cn/EN/Y2026/V14/I03/292

Figures/Tables 7

项目	总计（n=528）	预后良好组（n=226）	预后不良组（n=302）	统计值	P值
男性[例(%)]	309(58.52)	142(62.83)	167(55.30)	χ²=3.023	0.082
女性[例(%)]	219(41.48)	84(37.17)	135(44.70)	χ²=3.023	0.082
年龄（岁, $x ¯$ ±s）	69.26±0.70	68.37±0.52	65.42±0.85	t=6.498	0.011
既往病史[例(%)]
高血压	359(67.42)	144(63.70)	215(71.19)	χ²=3.319	0.068
糖尿病	138(26.52)	49(21.68)	88(29.10)	χ²=3.742	0.053
高脂血症	146(27.65)	61(26.99)	85(28.15)	χ²=0.086	0.769
心房颤动	238(46.97)	94(41.59)	144(47.70)	χ²=2.879	0.09
冠心病	96(17.05)	35(15.50)	61(20.20)	χ²=1.929	0.165
吸烟史	119(22.54)	53(23.45)	66(21.85)	χ²=0.189	0.664
卒中史	128(24.24)	53(23.45)	75(24.83)	χ²=0.135	0.714
发病到就诊时间[分, M(Q₁，Q₃)]	210(120, 360)	180(93.75, 300)	279.5(150, 420)	Z=-3.329	<0.001
静脉溶栓[例(%)]	132(25.00)	67(29.65)	65(21.52)	χ²=4.549	0.033
BMI[kg/m², M(Q₁，Q₃)]	26.96(19.89, 29.05)	28.56(26.98, 30.25)	27.72(22.03, 29.05)	Z=-0.027	0.978
D-二聚体水平[mg/L, M(Q₁，Q₃)]	0.63(0.24, 1.25)	0.50(0.22, 0.93)	0.77(0.24, 1.57)	Z=-4.643	<0.001
基线NIHSS评分[分, M(Q₁，Q₃)]	16(11, 20)	13(9, 17.25)	18(13, 22)	Z=-7.282	<0.001
卒中病因[例(%)]				χ²=2.184	0.336
大动脉粥样硬化型	243(46.02)	108(47.79)	135(44.70)
心源性栓塞型	258(48.86)	110(48.67)	148(49.01)
其他	27(5.11)	8(3.54)	19(6.29)

项目	总计（n=528）	预后良好组（n=226）	预后不良组（n=302）	统计值	P值
男性[例(%)]	309(58.52)	142(62.83)	167(55.30)	χ²=3.023	0.082
女性[例(%)]	219(41.48)	84(37.17)	135(44.70)	χ²=3.023	0.082
年龄（岁, $x ¯$ ±s）	69.26±0.70	68.37±0.52	65.42±0.85	t=6.498	0.011
既往病史[例(%)]
高血压	359(67.42)	144(63.70)	215(71.19)	χ²=3.319	0.068
糖尿病	138(26.52)	49(21.68)	88(29.10)	χ²=3.742	0.053
高脂血症	146(27.65)	61(26.99)	85(28.15)	χ²=0.086	0.769
心房颤动	238(46.97)	94(41.59)	144(47.70)	χ²=2.879	0.09
冠心病	96(17.05)	35(15.50)	61(20.20)	χ²=1.929	0.165
吸烟史	119(22.54)	53(23.45)	66(21.85)	χ²=0.189	0.664
卒中史	128(24.24)	53(23.45)	75(24.83)	χ²=0.135	0.714
发病到就诊时间[分, M(Q₁，Q₃)]	210(120, 360)	180(93.75, 300)	279.5(150, 420)	Z=-3.329	<0.001
静脉溶栓[例(%)]	132(25.00)	67(29.65)	65(21.52)	χ²=4.549	0.033
BMI[kg/m², M(Q₁，Q₃)]	26.96(19.89, 29.05)	28.56(26.98, 30.25)	27.72(22.03, 29.05)	Z=-0.027	0.978
D-二聚体水平[mg/L, M(Q₁，Q₃)]	0.63(0.24, 1.25)	0.50(0.22, 0.93)	0.77(0.24, 1.57)	Z=-4.643	<0.001
基线NIHSS评分[分, M(Q₁，Q₃)]	16(11, 20)	13(9, 17.25)	18(13, 22)	Z=-7.282	<0.001
卒中病因[例(%)]				χ²=2.184	0.336
大动脉粥样硬化型	243(46.02)	108(47.79)	135(44.70)
心源性栓塞型	258(48.86)	110(48.67)	148(49.01)
其他	27(5.11)	8(3.54)	19(6.29)

手术参数	预后良好组(n=226)	预后不良组(n=302)	统计值	P值
股动脉穿刺到再通时间[分, M(Q₁，Q₃)]	64.0(49.0, 82.0)	65.0(50.0, 92.0)	Z=-2.112	0.035
手术时间[分, M(Q₁，Q₃)]	101.5(75.0, 130.0)	110.0(80.0, 155.0)	Z=-2.279	0.023
MT次数[次, M(Q₁，Q₃)]	1(1, 2)	1(1, 2)	Z=-5.837	<0.001
保护伞装置使用[例(%)]	26(11.5)	29(9.6)	χ²=0.501	0.479
手术方式[例(%)]			χ²=0.624	0.429
MT	156(69.03)	218(72.19)
MT+血管成形	70(30.97)	84(27.81)
mTICI≥2b[例(%)]	224(99.12)	272(90.07)	χ²=18.591	<0.001

并发症及预后参数	预后良好组(n=226)	预后不良组(n=302)	χ²值	P值
症状性颅内出血[例(%)]	5 (2.21)	111(36.75)	89.971	<0.001
术中动脉穿孔[例(%)]	3(1.33)	5(1.66)	1.000	0.528
肺部感染[例(%)]	65(28.76)	105(34.77)	2.137	0.144

项目	B值	Wald卡方值	OR值（95% CI）	P值
常量	-3.063	8.200	OR=0.047	0.004
男性[例(%)]	-0.018	0.005	0.982(0.608~1.588)	0.942
年龄[岁, $x ¯$ ±s]	0.033	9.948	1.034(1.013~1.055)	0.002
高血压[例(%)]	-0.230	0.809	0.794(0.481~1.312)	0.368
糖尿病[例(%)]	-0.429	2.502	0.651(0.382~1.108)	0.114
心房颤动[例(%)]	0.006	0.109	1.093(0.644~1.856)	0.741
发病到就诊时间[分, M(Q₁，Q₃)]	0.002	12.736	1.002(1.001~1.003)	<0.001
静脉溶栓[例(%)]	0.006	0.001	1.006(0.587~1.722)	0.984
D-二聚体水平[mg/L, M(Q₁，Q₃)]	0.808	23.030	2.243(1.613~3.120)	<0.001
入院NIHSS评分[分, M(Q₁，Q₃)]	0.108	29.363	1.114(1.071~1.158)	<0.001
穿刺到再通时间[分, M(Q₁，Q₃)]	0.001	0.042	1.001(0.991~1.011)	0.838
手术时间[分, M(Q₁，Q₃)]	0.002	0.465	1.002(0.996~1.009)	0.495
MT次数[次, M(Q₁，Q₃)]	0.630	14.276	1.877(1.354~2.603)	<0.001
mTICI≥2b[例(%)]	1.737	4.709	5.681(1.183~27.276)	0.030
症状性颅内出血[例(%)]	-3.316	45.238	0.036(0.014~0.095)	<0.001

项目	B值	Wald卡方值	OR值（95% CI）	P值
常量	-3.063	8.200	OR=0.047	0.004
男性[例(%)]	-0.018	0.005	0.982(0.608~1.588)	0.942
年龄[岁, $x ¯$ ±s]	0.033	9.948	1.034(1.013~1.055)	0.002
高血压[例(%)]	-0.230	0.809	0.794(0.481~1.312)	0.368
糖尿病[例(%)]	-0.429	2.502	0.651(0.382~1.108)	0.114
心房颤动[例(%)]	0.006	0.109	1.093(0.644~1.856)	0.741
发病到就诊时间[分, M(Q₁，Q₃)]	0.002	12.736	1.002(1.001~1.003)	<0.001
静脉溶栓[例(%)]	0.006	0.001	1.006(0.587~1.722)	0.984
D-二聚体水平[mg/L, M(Q₁，Q₃)]	0.808	23.030	2.243(1.613~3.120)	<0.001
入院NIHSS评分[分, M(Q₁，Q₃)]	0.108	29.363	1.114(1.071~1.158)	<0.001
穿刺到再通时间[分, M(Q₁，Q₃)]	0.001	0.042	1.001(0.991~1.011)	0.838
手术时间[分, M(Q₁，Q₃)]	0.002	0.465	1.002(0.996~1.009)	0.495
MT次数[次, M(Q₁，Q₃)]	0.630	14.276	1.877(1.354~2.603)	<0.001
mTICI≥2b[例(%)]	1.737	4.709	5.681(1.183~27.276)	0.030
症状性颅内出血[例(%)]	-3.316	45.238	0.036(0.014~0.095)	<0.001

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