Predicting Futile Recanalization After Endovascular Thrombectomy for Patients With Stroke With Large Cores: The SNAP Score.
Publication/Presentation Date
5-1-2025
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.
Volume
96
Issue
5
First Page
1080
Last Page
1088
ISSN
1524-4040
Published In/Presented At
Matsukawa, H., Chen, H., Elawady, S. S., Cunningham, C., Uchida, K., Sowlat, M. M., Maier, I., Jabbour, P., Kim, J. T., Wolfe, S. Q., Rai, A., Starke, R. M., Psychogios, M. N., Samaniego, E. A., Arthur, A., Yoshimura, S., Cuellar, H., Grossberg, J. A., Alawieh, A., Romano, D. G., … Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators (2025). Predicting Futile Recanalization After Endovascular Thrombectomy for Patients With Stroke With Large Cores: The SNAP Score. Neurosurgery, 96(5), 1080–1088. https://doi.org/10.1227/neu.0000000000003220
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
39471074
Department(s)
Administration and Leadership
Document Type
Article