Histogram characteristics of thrombus predict successful recanalization and reperfusion of patients with mechanical thrombectomy

LIU Song; FU Lejun; REN Tao; SUN Yu; WEI Ming; JIN Song; TIAN Chao; XIA Shuang

doi:10.19300/j.2025.L21927

Abstract：Objective This study aims to explore the predictive value of thrombus histogram features for successful recanalization and reperfusion after mechanical thrombectomy(MT)in patients with acute ischemic stroke(AIS),and to assess the clinical applicability of these features in preoperative imaging evaluation.Methods We retrospectively collected clinical and imaging data from 98 patients who underwent MT for AIS.All patients underwent non-contrast cranial CT and CT angiography(CTA),and thrombus histogram features such as mean,standard deviation,skewness,and kurtosis were measured from original images using Image J software.Patients were categorized into the successful recanalization group(n=65)and failed recanalization group(n=33)based on the recanalization status,and the successful reperfusion group(n=70)and failed reperfusion group(n=28)based on the reperfusion status.Differences between groups were compared using t-test,Mann-Whitney U test,Chi-square test,and Fisher's exact test.Multivariate logistic regression was used to identify independent predictors,and to establish nomogram models.Calibration curves and decision curve analysis were performed to evaluate model stability and clinical utility.Results Compared with the failed recanalization group,successful recanalization group had a shorter onset time and higher thrombus CTA skewness(both P<0.05).Similarly,there were significant differences in onset time and thrombus CTA skewness between the successful and failed reperfusion groups(both P<0.05).Multivariate logistic regression analysis indicated that onset time and thrombus CTA skewness were independent predictors of both recanalization and reperfusion(both P<0.05).Nomogram models were constructed to predict recanalization and reperfusion based on thrombus CTA skewness and onset time.Calibration curves showed good agreement between the predicted and actual values for recanalization and reperfusion(P=0.862 and 0.831,respectively).Decision curve analysis indicated that the nomogram models had good clinical applicability for predicting recanalization and reperfusion.Conclusion The skewness of thrombus histogram features demonstrates potential predictive value for assessing recanalization and reperfusion status following mechanical thrombectomy,serving as a novel reference indicator in preoperative imaging evaluation that facilitates personalized treatment strategies for AIS.