Risk factors for thrombus migration during mechanical thrombectomy for acute ischemic stroke with large vessel occlusion and its nomogram prediction model

SANG Chunsheng; WANG Jianren; LU Hua; FU Xi'an

doi:10.3969/j.issn.1671-2897.2026.01.010

Abstract：Objective To explore the risk factors for thrombus migration during mechanical thrombectomy for acute ischemic stroke with large vessel occlusion(AIS-LVO),and establish a nomogram prediction model.Methods A retrospective analysis was conducted on the clinical data of 171 patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)who received mechanical thrombectomy at Suzhou Hospital Affiliated to Nanjing Medical University from December 2019 to December 2024.According to the occurrence of thrombus migration during mechanical thrombectomy,the patients were divided into the thrombus migration group(n=62)and the non-thrombus migration group(n=109).The clinical data between the two groups were compared,and those with statistically significant differences(P<0.05)were included in the multivariate logistic regression analysis to screen the independent risk factors for thrombus migration during the operation and construct a nomogram model.The efficiency,goodness of fit and benefit of the established model were tested through internal validation.Results Univariate analysis showed that there were statistically significant differences in the history of diabetes,bridging therapy,number of thrombectomy procedures,clot burden score(CBS),high-density vessel sign,primary thrombectomy strategy,thrombus location,and collateral status between the two groups(P<0.05).Multivariate logistic regression analysis showed that bridging therapy(OR=3.33,95%CI:1.44～7.72,P=0.005),the number of thrombectomy procedures>1 time(OR=8.82,95%CI:3.12～24.94,P<0.001),posterior circulation thrombosis(OR=4.17,95%CI:1.17～14.83,P=0.027),and poor collateral status(OR=5.27,95%CI:2.26～12.28,P<0.001)were all independent risk factors for thrombus migration during mechanical thrombectomy for AIS-LVO(P<0.05).A nomogram prediction model was established based on the above risk factors.The verification results showed that the area under the curve was 0.82,the Hosmer-Lemeshow test χ2=6.536,P=0.587,and the decision curve showed that when the threshold probability was in the range of 0.08 to 0.94,there was a relatively higher net benefit value.Conclusions The nomogram model constructed on the status of bridging therapy,the number of thrombectomy procedures,location of the thrombus in the posterior circulation,and collateral status can predict the probability of thrombus migration during the mechanical thrombectomy treatment for AIS-LVO.