Association between CHADS2, CHA2DS2-VASc, ATRIA, and Essen Stroke Risk Scores and Unsuccessful Recanalization after Endovascular Thrombectomy in Acute Ischemic Stroke Patients

Hyung Jun Kim, Moo-Seok Park, Joonsang Yoo, Young Dae Kim, Hyungjong Park, Byung Moon Kim, Oh Young Bang, Hyeon Chang Kim, Euna Han, Dong Joon Kim, JoonNyung Heo, Jin Kyo Choi, Kyung-Yul Lee, Hye Sun Lee, Dong Hoon Shin, Hye-Yeon Choi, Sung-Il Sohn, Jeong-Ho Hong, Jong Yun Lee, Jang-Hyun Baek, Gyu Sik Kim, Woo-Keun Seo, Jong-Won Chung, Seo Hyun Kim, Sang Won Han, Joong Hyun Park, Jinkwon Kim, Yo Han Jung, Han-Jin Cho, Seong Hwan Ahn, Sung Ik Lee, Kwon-Duk Seo, Yoonkyung Chang, Tae-Jin Song, Hyo Suk Nam, SECRET Study Investigators, Hyung Jun Kim, Moo-Seok Park, Joonsang Yoo, Young Dae Kim, Hyungjong Park, Byung Moon Kim, Oh Young Bang, Hyeon Chang Kim, Euna Han, Dong Joon Kim, JoonNyung Heo, Jin Kyo Choi, Kyung-Yul Lee, Hye Sun Lee, Dong Hoon Shin, Hye-Yeon Choi, Sung-Il Sohn, Jeong-Ho Hong, Jong Yun Lee, Jang-Hyun Baek, Gyu Sik Kim, Woo-Keun Seo, Jong-Won Chung, Seo Hyun Kim, Sang Won Han, Joong Hyun Park, Jinkwon Kim, Yo Han Jung, Han-Jin Cho, Seong Hwan Ahn, Sung Ik Lee, Kwon-Duk Seo, Yoonkyung Chang, Tae-Jin Song, Hyo Suk Nam, SECRET Study Investigators

Abstract

Background: The CHADS2, CHA2DS2-VASc, ATRIA, and Essen scores have been developed for predicting vascular outcomes in stroke patients. We investigated the association between these stroke risk scores and unsuccessful recanalization after endovascular thrombectomy (EVT).

Methods: From the nationwide multicenter registry (Selection Criteria in Endovascular Thrombectomy and Thrombolytic therapy (SECRET)) (Clinicaltrials.gov NCT02964052), we consecutively included 501 patients who underwent EVT. We identified pre-admission stroke risk scores in each included patient.

Results: Among 501 patients who underwent EVT, 410 (81.8%) patients achieved successful recanalization (mTICI ≥ 2b). Adjusting for body mass index and p < 0.1 in univariable analysis revealed the association between all stroke risk scores and unsuccessful recanalization (CHADS2 score: odds ratio (OR) 1.551, 95% confidence interval (CI) 1.198-2.009, p = 0.001; CHA2DS2VASc score: OR 1.269, 95% CI 1.080-1.492, p = 0.004; ATRIA score: OR 1.089, 95% CI 1.011-1.174, p = 0.024; and Essen score: OR 1.469, 95% CI 1.167-1.849, p = 0.001). The CHADS2 score had the highest AUC value and differed significantly only from the Essen score (AUC of CHADS2 score; 0.618, 95% CI 0.554-0.681).

Conclusion: All stroke risk scores were associated with unsuccessful recanalization after EVT. Our study suggests that these stroke risk scores could be used to predict recanalization in stroke patients undergoing EVT.

Keywords: ischemic stroke; recanalization; stroke risk score; thrombectomy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient selection strategy used in the study. tPA, tissue plasminogen activator; EVT, endovascular thrombectomy; mTICI, modified thrombolysis in cerebral infarction.
Figure 2
Figure 2
Forest plots of unadjusted odds ratios for unsuccessful recanalization (mTICI ≤ 2a) in patients with endovascular thrombectomy. BMI, body mass index; NIHSS, National Institutes of Health Stroke Scale; LNT, last normal time; IA, intra-arterial; IV, intra-venous; ORs, odds ratios; mTICI, modified thrombolysis in cerebral infarction.
Figure 3
Figure 3
Receiver operating characteristic curve analyses of unsuccessful recanalization based on stroke risk scores. (A) Univariable ROC analysis (B) Multivariable ROC analysis. ROC, receiver operating characteristic.

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