Journal article
Predicting Futile Recanalization After Endovascular Thrombectomy for Patients With Stroke With Large Cores: The SNAP Score
Neurosurgery, Vol.96(5), pp.1080-1088
05/2025
DOI: 10.1227/neu.0000000000003220
PMID: 39471074
Abstract
BACKGROUND AND OBJECTIVES: We aimed to develop and validate a prediction score for futile recanalization (FR) for large vessel occlusion (LVO) presenting low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) for patients who underwent endovascular thrombectomy (EVT). METHODS: Patients with anterior circulation LVO with low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score ≥2b) from Stroke Thrombectomy and Aneurysm Registry were retrospectively analyzed. FR was defined as 90-day modified Rankin Scale (mRS) scores ≥4 despite successful EVT. Multivariable logistic regression was used to identify independent predictors of FR, and they were used to create a clinical score. The performance of the score was assessed by receiver operating characteristic curve analyses. RESULTS: Of 219 patients, 170 and 49 patients were randomly assigned to the training and validation cohort, respectively. Independent predictors of FR identified in the training cohort were used to construct the SNAP score: site of occlusion (middle cerebral artery = 0, internal carotid artery = 1), National Institutes of Health Stroke Scale score at admission (≤10 = 0, 10 to 19 = 1, ≥20 = 2), age (<75 = 0, ≥75 = 2), and prestroke mRS score (0-3). Receiver operating characteristic curve analyses of the SNAP score in the training and validation cohorts showed areas under the curve of 0.79 (95% CI 0.72-0.86) and 0.79 (95% CI 0.65-0.92) for predicting FR, respectively. A SNAP score ≥5 had a positive predictive value of 92.1% [95% CI 78.8%-97.3%] for FR. CONCLUSION: The SNAP score may be useful in predicting FR after EVT in low-ASPECTS patients with LVO. It can provide patients, family members, and physicians with reliable outcome expectations among patients with acute ischemic stroke with large infarcts.
Details
- Title: Subtitle
- Predicting Futile Recanalization After Endovascular Thrombectomy for Patients With Stroke With Large Cores: The SNAP Score
- Creators
- Hidetoshi Matsukawa - Medical University of South CarolinaHuanwen Chen - National Institute of Neurological Disorders and StrokeSameh Samir Elawady - Medical University of South CarolinaConor Cunningham - Medical University of South CarolinaKazutaka Uchida - Hyogo UniversityMohammad-Mahdi Sowlat - Medical University of South CarolinaIlko Maier - Universitätsmedizin GöttingenPascal Jabbour - Jefferson University HospitalsJoon-Tae Kim - Chonnam National University HospitalStacey Quintero Wolfe - Wake Forest UniversityAnsaar Rai - West Virginia UniversityRobert M. Starke - University of Miami Health SystemMarios-Nikos Psychogios - University of BaselEdgar A. Samaniego - University of IowaAdam Arthur - University of Tennessee Health Science CenterShinichi Yoshimura - Hyogo UniversityHugo Cuellar - Louisiana State UniversityJonathan A. Grossberg - Emory UniversityAli Alawieh - Emory UniversityDaniele G. Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaOmar Tanweer - Baylor College of MedicineJustin Mascitelli - The University of Texas at San Antonio Health Science CenterIsabel Fragata - Unidade Local de Saúde de São JoséAdam Polifka - University of FloridaJoshua Osbun - Washington University in St. LouisRoberto Crosa - Department of Neurosurgery, Endovascular Neurological Center, Montevideo, UruguayCharles Matouk - Yale UniversityMin S. Park - University of VirginiaMichael R. Levitt - University of WashingtonWaleed Brinjikji - Mayo ClinicMark Moss - Washington Regional Medical CenterRichard Williamson - Allegheny Health NetworkPedro Navia - Hospital Universitario La PazPeter Kan - The University of Texas Medical Branch at GalvestonReade De Leacy - Mount Sinai Health SystemShakeel Chowdhry - NorthShore University HealthSystemMohamad Ezzeldin - University of HoustonAlejandro M. Spiotta - Medical University of South CarolinaStroke Thrombectomy and Aneurysm Registry (STAR) Collaborators
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.96(5), pp.1080-1088
- DOI
- 10.1227/neu.0000000000003220
- PMID
- 39471074
- NLM abbreviation
- Neurosurgery
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Language
- English
- Electronic publication date
- 10/11/2024
- Date published
- 05/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984736737802771
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