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

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.

Association between CHADS2, CHA2DS2-VASc, ATRIA, and Essen Stroke Risk Scores and Functional Outcomes in Acute Ischemic Stroke Patients Who Received Endovascular Thrombectomy

“…Successful recanalization is more likely to influence functional outcomes than other factors that contribute to the stroke risk score. We previously reported that the CHADS 2 , CHA 2 DS 2 -VASc, ATRIA, and Essen scores could be used to predict recanalization in stroke patients receiving EVT [ 19 ]. We explored associations between stroke risk scores and functional outcomes at 3 months and found a positive association between all stroke risk scores and unfavorable outcomes after adjusting for covariates that could be identified before the procedure, whereas there was a positive association between CHADS 2 and ATRIA scores and unfavorable outcomes in multivariable regression analysis after covariate adjustment, including successful recanalization.…”

“…All patient information was anonymized and audited by the main center. Demographic data, comorbidities, including vascular risk factors, medication history, and laboratory results, neurologic status, including severity and functional outcomes, variables of reperfusion therapy (time parameters for tPA and EVT, techniques, devices, and treatment-related complications), and imaging findings before and after reperfusion therapy were collected for all patients [ 19 , 23 ]. The SECRET study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Yonsei University College of Medicine (4-2015-1196).…”

“…These stroke risk scores are also correlated with other vascular outcomes, such as cerebral atherosclerosis in AF patients [ 17 ]. Associations between these stroke risk scores and vascular outcomes were reported not only in AF patients but also in all stroke patients [ 18 , 19 ]. For the Essen score, recurrent ischemic stroke risk increases with increasing score in ischemic stroke patients [ 20 ].…”

Recent Advances in Targeted Nanotherapies for Ischemic Stroke

“…Intravenous thrombolysis is the standard resuscitation measure to minimize brain damage. , Although thrombolytic therapy is strictly time-limited, timely thrombolysis can be effective in relieving neurological damage. , The recombinant fibrinogen activator rtPA is the only effective thrombolytic agent approved by the FDA for clinical use in acute IS. , However, because of the short therapeutic window suitable for most patients (≤4.5 h), with the development of new thrombolytic agents and advanced imaging techniques that allow longer thrombolysis times based on advanced imaging, the concept of tissue time window has been proposed and the treatment time window has been extended to 6 h . Among other limitations, the therapeutic effect of rtPA is often unsatisfactory. , Additionally, a high risk of reperfusion injury and cerebral hemorrhage remain after thrombolysis . Mechanical thrombectomy is also used clinically to treat IS.…”

“…11,12 However, because of the short therapeutic window suitable for most patients (≤4.5 h), with the development of new thrombolytic agents and advanced imaging techniques that allow longer thrombolysis times based on advanced imaging, the concept of tissue time window has been proposed and the treatment time window has been extended to 6 h. 13 Among other limitations, 14 the therapeutic effect of rtPA is often unsatisfactory. 12,15 Additionally, a high risk of reperfusion injury and cerebral hemorrhage remain after thrombolysis. 16 Mechanical thrombectomy is also used clinically to treat IS.…”