Predicting Futile Recanalization by Cerebral Collateral Recycle Status in Patients with Endovascular Stroke Treatment: The CHANOA Score.

Abstract

Rationale and objectives: The correlation between collateral circulation and futile recanalization (FR) is still controversial, and few studies have explored the influence of comprehensive cerebral collateral circulation on FR after endovascular stroke treatment. Therefore, based on cerebral collateral recycle (CCR) status, we aimed to establish an effective scoring system to identify the probability of FR.

Methods: This was a multicenter retrospective cohort study. FR was defined as a 90-day modified Rankin Scale (mRS) score of 3-6, despite having successful recanalization (modified Thrombolysis in Cerebral Infarction score of 2b-3). The discrimination and calibration of this score were assessed using the area under the receiver operator characteristic curve, calibration curve, and decision curve analysis.

Results: Out of 860 patients receiving endovascular stroke treatment, 478 were enrolled in this study after strict screening. In multivariate regression analysis, the CCR status (poor CCR, adjusted OR[aOR] 9.99, 95%CI 5.11 to 17.06, P < 0.001; moderate CCR, aOR 2.94, 95%CI 1.71 -5.06, P < 0.001), age ≥ 80 years (aOR 3.77, P < 0.001), baseline NIHSS ≥ 15 (aOR 1.81, P = 0.018), baseline ASPECTS ≤ 6 (aOR 1.95, P = 0.006), the time from stroke onset to revascularization (OTR) ≥ 600 min (aOR 2.02, P = 0.007) and any intracranial hemorrhage within 48 h (aOR 3.54, P < 0.001) were significantly associated with FR. These factors make up the CCR-hemorrhage-age-NIHSS-OTR-ASPECTS (CHANOA) score. The CHANOA score demonstrated good discrimination and calibration in this cohort, as well as the fivefold cross validation.

Conclusion: The CHANOA score reliably predicted FR in patients with endovascular stroke treatment, based on comprehensive cerebral collateral and clinical features.