The BAND score: a simple upfront predictive model for futile recanalization to guide patient selection for endovascular thrombectomy during acute ischemic stroke triage (P8-5.004)

Abstract

<h3>Objective:</h3> To develop a clinical scoring system for upfront prediction of poor post-endovascular thrombectomy (EVT) outcomes during the acute stroke triage process. <h3>Background:</h3> Futile recanalization (FR) is an unfavorable outcome following successful EVT for acute ischemic stroke patients. There is currently no clinical scoring system that can accurately predict FR. <h3>Design/Methods:</h3> Consecutive EVT patients for anterior circulation large vessel occlusion strokes were identified from 2016 to 2021 at a Comprehensive Stroke Center, and clinical information was recorded. FR was defined as a 90-day modified Rankin Scale (mRS) of 4 or greater despite achieving modified thrombolysis in cerebral infarction (mTICI) score 2b or greater. Multivariable regression analyses were used to identify independent risk factors for FR, and a scoring system was constructed. <h3>Results:</h3> 619 patients were identified, and 483 patients with successful recanalization and available 90-day follow-up data were analyzed. Overall, FR was observed in 46.5% of patients. From a randomly selected training cohort (n=357), individual risk factors for FR were identified and used to construct the 10-point BAND score: baseline disability (1 point: baseline mRS ≥ 2), age (1 point: 60–69 years, 2 points: 70–79 years, 3 points: 80–84 years, 4 points: 85 years or older), NIHSS (2 points: 13–17, 3 points: 18–22, and 4 points: 23 or higher), and delay from last known normal (1 point: ≥6 hours). The BAND score achieved good predictability of FR with an area under the receiver-operating characteristic curve of 0.80 in our training cohort and 0.78 in our validation cohort. 88.2% of the total and 90.2% of patients 80 years or older with BAND ≥7 had a 90-day mRS of 4 or greater despite successful EVT recanalization. <h3>Conclusions:</h3> The BAND score is a simple clinical scoring system for prediction of FR, and it has potential to serve as a valuable triage tool for physicians in a real-world setting. <b>Disclosure:</b> Mr. Chen has received research support from National Institues of Health. Dr. Colasurdo has nothing to disclose. Dr. Phipps has nothing to disclose. The institution of Dr. Miller has received research support from Medtronic. The institution of Dr. Miller has received research support from Cerenovus, DePuy Synthes Products, Inc.. The institution of Dr. Miller has received research support from InSightec. The institution of Dr. Miller has received research support from Microvention. The institution of Dr. Miller has received research support from Microvention. The institution of Dr. Miller has received research support from InSightec. The institution of Dr. Miller has received research support from MicroVention. The institution of Dr. Miller has received research support from InSightec. The institution of Dr. Miller has received research support from Vesalio. Jacob Cherian has nothing to disclose. Dr. Marino Granados has nothing to disclose. Dr. Cronin has nothing to disclose. Dr. Wozniak has nothing to disclose. Dheeraj Gandhi has nothing to disclose. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Calgary. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Ramar &amp; Paradiso. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Cole, Scott, Kissane. The institution of Dr. Chaturvedi has received research support from NINDS. Gaurav Jindal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Penumbra.