Construction and validation of a predictive model for reocclusion after mechanical thrombectomy in patients with acute large vessel occlusive cerebral infarction

Li Chunmiao; Lu Wenwen; Yan Wenqian; He Runyuan; Wang Lina; Zhang Yun

doi:10.3969/j.issn.1002-1949.2025.09.007

Abstract：Objective To analyze the influencing factors of reocclusion in the patients of acute ischemic stroke with large vessel occlusion(AIS-LVO)after mechanical thrombectomy,and to construct a predictive model to guide clinical decision-making.Methods This study was a retrospective analysis,the clinical data of 312 AIS-LVO patients underwent mechanical thrombectomy treatment in Yuncheng Central Hospital affiliated to Shanxi Medical University from January 2021 to December 2024 were collected.According to the occurrence of reocclusion within 72 h after surgery,the patients were divided into non-occlusion group(n=287)and reocclusion group(n=25).The relevant data of the two groups were compared,and the influencing factors of postoperative reocclusion in the patients were analyzed by Logistic regression model.Based on this,a nomogram prediction model was constructed,and the prediction efficiency of the model was evaluated for internal validation through calibration curve and decision curve.Results The National Institutes of Health Stroke Scale(NIHSS)score and homocysteine(Hcy)levels in the reocclusion group were higher than those in the non-occlusion group before surgery.The proportion of target vessel stenosis,multiple thrombectomy during surgery,postoperative thrombus escape,and no use of tirofiban during the perioperative period in the reocclusion group were higher than those in the non-occlusion group.The preoperative platelet-derived growth factor(PDGF)level was lower than that in the non-occlusion group(P＜0.05).Logistic regression analysis showed that preoperative NIHSS score,PDGF level,intraoperative thrombectomy frequency,and postoperative thrombus escape were all influencing factors for the occurrence of postoperative reocclusion in AIS-LVO patients undergoing mechanical thrombectomy(P＜0.05).Nomogram prediction model.The results showed that the consistency index(C-index)of the model in predicting the risk of reocclusion after mechanical thrombectomy in AIS-LVO patients was 0.933,indicating good discrimination of prediction model.A calibration curve was drawn,and the results showed that it approached the ideal curve with good consistency.Decision curve showed that within the risk threshold range of 0.00-0.80,the clinical net benefit rate of the model was always greater than 0,indicating good clinical practicality of the model.Conclusions The risk of reocclusion in the patients undergoing AIS-LVO mechanical thrombectomy is related to preoperative NIHSS score,PDGF level,intraoperative thrombectomy frequency,and postoperative thrombus escape.The predictive model constructed based on this has ideal discrimination,consistency,and predictive efficacy for the risk of reocclusion in the patients.