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Background and Purpose Prediction of futile recanalization (FR), i.e. failure of long-term functional independence despite full reperfusion in mechanical thrombectomy (MT), is instrumental in patients undergoing endovascular therapy. Methods Retrospective single-center analysis of patients treated for anterior circulation LVO ensuing successful MT (mTICI 2c–3) between January 2014 and April 2019. FR was defined as modified Rankin Scale (mRS) 90 days after stroke onset > 2 or mRS > pre-stroke mRS. Multivariable analysis was performed with variables available before treatment initiation regarding their association with FR. Performance of the regression model was then compared with a model including parameters available after MT. Results Successful MT was experienced by 549/1146 patients in total. FR occurred in 262/549 (47.7%) patients. Independent predictors of FR were male sex, odds ratio (OR) with 95% confidence interval (CI) 1.98 (1.31–3.05, p 0.001), age (OR 1.05, CI 1.03–1.07, p p p 0.025), neutrophile-lymphocyte ratio (OR 1.03, CI 1.00–1.06, p 0.022), baseline ASPECTS (OR 0.77, CI 0.68–0.88, p p 0.016). The prediction model’s Area Under the Curve was 0.78 (CI 0.74–0.82) and increased with parameters available after MT to 0.86 (CI 0.83–0.89) with failure of early neurological improvement being the most important predictor of FR (OR 15.0, CI 7.2–33.8). Conclusion A variety of preinterventional factors may predict FR with substantial certainty, but the prediction model can still be improved by considering parameters only available after MT, in particular early neurological improvement.

Background and aim The aim of this study was to assess the diagnostic accuracy of e-CTA (product name) (Brainomix) in the automatic detection of large vessel occlusions in anterior circulation stroke. Methods Of 487 CT angiographies from patients with large vessel occlusions stroke, 327 were used to train the algorithm while the remaining cases together with 140 negative CT angiographies were used to validate its performance against ground truth. Of these 301 cases, 144 were randomly selected and used for an additional comparative analysis against 4 raters. Sensitivity, specificity, positive and negative predictive value (PPV and NPV), accuracy and level of agreement with ground truth (Cohen’s Kappa) were determined and compared to the performance of a neuroradiologist, a radiology resident, and two neurology residents. Results e-CTA had a sensitivity and specificity of 0.84 (0.77–0.89) and 0.96 (0.91–0.98) respectively for the detection of any large vessel occlusions on the correct side in the whole validation cohort. This performance was identical in the comparative analysis subgroup and was within the range of physicians at different levels of expertise: 0.86–0.97 and 0.91–1.00, respectively. For the detection of proximal occlusions, it was 0.92 (0.84–0.96) and 0.98 (0.94–1.00) for the whole cohort and 0.93 (0.80–0.98) and 1.00 (0.95–1.00) for the comparative analysis, respectively for e-CTA. The range was 0.8–0.97 for sensitivity and 0.97–1.00 for specificity for the four physicians. Conclusions The performance of e-CTA in detecting any large vessel occlusions is comparable to less experienced physicians but is similar to experienced physicians for detecting proximal large vessel occlusions.

Background and Purpose: Failure of early neurological improvement (fENI) despite successful mechanical thrombectomy in the anterior circulation is a clinically frequent occurrence. Purpose of this analysis was to define independent clinical, radiological, laboratory, or procedural predictors for fENI. Methods: Retrospective single-center analysis of patients treated for acute ischemic stroke in the anterior circulation ensuing successful mechanical thrombectomy between January 2014 and April 2019. Patients were compared according to fENI (equal or higher National Institutes of Health Stroke Scale) and ENI (lower National Institutes of Health Stroke Scale at discharge). Thirty-eight variables were examined in multivariable analysis for association with fENI. Results: Five hundred forty-nine out of 1146 patients experienced successful recanalization (modified Treatment in Cerebral Ischemia 2c-3). fENI occurred in 115/549 (20.9%) patients. Independent predictors of fENI were premorbid modified Rankin Scale (odds ratio [OR] per point [IC], 1.21 [1.00–1.46], P =0.049), end-stage renal failure (OR [IC], 12.18 [2.01–73.63], P =0.007), admission glucose (OR [IC], 1.018 [1.004–1.013] per mg/dL, P =0.001), bridging IV lysis (OR [IC], 0.57 [0.35–0.93], P : 0.024), time from groin puncture to final recanalization (OR [IC], 1.004 [1.001–1.007] per minute, P =0.015), general anesthesia during mechanical thrombectomy (OR, 2.41 [1.43–4.08], P P =0.004), and follow-up Alberta Stroke Program Early CT Score (OR [IC], 0.76 [0.69–0.84] per point, P P Conclusions: The extent of infarction and the involvement of motor cortex and internal capsule as well as higher premorbid modified Rankin Scale, end-stage renal failure, high glucose level on admission, absence of bridging IV lysis, general anesthesia, and a longer therapy interval are presumably independent predictors for fENI in patients with successful mechanical thrombectomy.

Supplemental material, sj-pdf-2-wso-10.1177_1747493021992592 for Diagnostic accuracy of automated occlusion detection in CT angiography using e-CTA by Fatih Seker, Johannes Alex Rolf Pfaff, Yahia Mokli, Anne Berberich, Rafael Namias, Steven Gerry, Simon Nagel, Martin Bendszus and Christian Herweh in International Journal of Stroke

Supplemental material, sj-pdf-3-wso-10.1177_1747493021992592 for Diagnostic accuracy of automated occlusion detection in CT angiography using e-CTA by Fatih Seker, Johannes Alex Rolf Pfaff, Yahia Mokli, Anne Berberich, Rafael Namias, Steven Gerry, Simon Nagel, Martin Bendszus and Christian Herweh in International Journal of Stroke

Supplemental material, sj-pdf-1-wso-10.1177_1747493021992592 for Diagnostic accuracy of automated occlusion detection in CT angiography using e-CTA by Fatih Seker, Johannes Alex Rolf Pfaff, Yahia Mokli, Anne Berberich, Rafael Namias, Steven Gerry, Simon Nagel, Martin Bendszus and Christian Herweh in International Journal of Stroke