Publicação

FRET score

Detalhes bibliográficos
Resumo:	INTRODUCTION: Endovascular thrombectomy (EVT) is the treatment of choice for LVO stroke, yet nearly half of successfully recanalised patients fail to achieve functional independence, a phenomenon termed futile recanalisation (FR). Predictors of FR remain poorly defined in large, heterogeneous populations. Therefore, we aimed to develop a predictive score for FR. PATIENTS AND METHODS: Endovascular thrombectomy-treated LVO patients from the prospective, multicentre EVATRISP collaboration were included. All patients had known pre-stroke functional status, modified thrombolysis in cerebral infarction (mTICI) score and 90-day mRS. Futile recanalisation was defined as mRS > 2 at 90 days despite mTICI ≥ 2b. Patients with FR were compared to those with successful recanalisation and mRS ≤ 2. The cohort was randomly split into derivation (70%) and validation (30%) sets. Multivariable logistic regression identified independent predictors that were used to construct the futile recanalisation following endovascular thrombectomy (FRET) score. RESULTS: Of 9909 patients, 7272 (73%) achieved successful recanalisation and 3420 (47%) of them experienced FR. In the derivation set, FR was independently associated with older age, diabetes, ischaemic heart disease, higher NIHSS, anterior cerebral artery occlusion, seizures at presentation, non-use of intravenous thrombolysis and lower Alberta Stroke Program Early CT Score (ASPECTS) or posterior circulation ASPECTS. Futile recanalisation patients had longer hospital stays and higher mortality rates. The FRET score demonstrated good discrimination (area under the curve [AUC] 0.721; 95% CI, 0.702-0.740), with FRET ≥ 3 indicating high risk. The validation cohort yielded similar performance (AUC 0.708; 95% CI, 0.680-0.737). CONCLUSION: The FRET score enables early identification of EVT patients at high risk for FR.
Autores principais:	Schwartzmann, Yoel
Outros Autores:	Heldner, Mirjam R.; Jubran, Hamza; Arnold, Marcel; Breiding, Philipe S.; Shalabi, Fatma; Jubeh, Tamer; Metanis, Issa; Nordanstig, Annika; Nederkoorn, Paul J.; Wali, Nabila; van der Meij, Anne; Wegener, Susanne; Otto, Lukas; Handelsmann, Hannah Lea; Michel, Patrik; Strambo, Davide; Salerno, Alexander; De Marchis, Gian Marco; Dittrich, Tolga; Curtze, Sami; Martinez-Majander, Nicolas; Gensicke, Henrik; Engelter, Stefan; Altersberger, Valerian; Trüssel, Simon; Nolte, Christian H.; Riegler, Christoph; Zini, Andrea; Naldi, Federica; Bigliardi, Guido; Picchetto, Livio; Marto, Joao Pedro; Costa, José Pedro; Molad, Jeremy; Hallevi, Hen; Cereda, Carlo W.; Pezzini, Alessandro; Magoni, Mauro; Padjen, Visnja; Zedde, Marialuisa; Leker, Ronen R.
Assunto:	endovascular treatment futile recanalisation large vessel occlusion stroke Clinical Neurology Cardiology and Cardiovascular Medicine SDG 3 - Good Health and Well-being
Ano:	2026
País:	Portugal
Tipo de documento:	artigo
Tipo de acesso:	acesso aberto
Instituição associada:	Universidade Nova de Lisboa
Idioma:	inglês
Origem:	Repositório Institucional da UNL

Descrição
Resumo:	INTRODUCTION: Endovascular thrombectomy (EVT) is the treatment of choice for LVO stroke, yet nearly half of successfully recanalised patients fail to achieve functional independence, a phenomenon termed futile recanalisation (FR). Predictors of FR remain poorly defined in large, heterogeneous populations. Therefore, we aimed to develop a predictive score for FR. PATIENTS AND METHODS: Endovascular thrombectomy-treated LVO patients from the prospective, multicentre EVATRISP collaboration were included. All patients had known pre-stroke functional status, modified thrombolysis in cerebral infarction (mTICI) score and 90-day mRS. Futile recanalisation was defined as mRS > 2 at 90 days despite mTICI ≥ 2b. Patients with FR were compared to those with successful recanalisation and mRS ≤ 2. The cohort was randomly split into derivation (70%) and validation (30%) sets. Multivariable logistic regression identified independent predictors that were used to construct the futile recanalisation following endovascular thrombectomy (FRET) score. RESULTS: Of 9909 patients, 7272 (73%) achieved successful recanalisation and 3420 (47%) of them experienced FR. In the derivation set, FR was independently associated with older age, diabetes, ischaemic heart disease, higher NIHSS, anterior cerebral artery occlusion, seizures at presentation, non-use of intravenous thrombolysis and lower Alberta Stroke Program Early CT Score (ASPECTS) or posterior circulation ASPECTS. Futile recanalisation patients had longer hospital stays and higher mortality rates. The FRET score demonstrated good discrimination (area under the curve [AUC] 0.721; 95% CI, 0.702-0.740), with FRET ≥ 3 indicating high risk. The validation cohort yielded similar performance (AUC 0.708; 95% CI, 0.680-0.737). CONCLUSION: The FRET score enables early identification of EVT patients at high risk for FR.