Is Personalized Mechanical Thrombectomy Based on Clot Characteristics Feasible? A Radiomics Model Using NCECT to Predict FPE in AIS Patients Undergoing Thromboaspiration

<b>Background/Objectives</b>: In patients with acute ischemic stroke (AIS), the first pass effect (FPE) refers to the complete recanalization of an occluded vessel (TICI = 2C/3) with a single thrombectomy attempt. Achieving complete vessel recanalization is associated with better functional outcomes compared to lower reperfusion rates (TICI < 2B). There is no consensus on which thrombectomy technique provides the best recanalization results for AIS patients. Furthermore, there is a paucity of tools available to predict FPE prior to mechanical thrombectomy (MT). The objective of this study is to develop a radiomics model based on brain NCECT to predict which patients are more likely to achieve a FPE with thromboaspiration MT. <b>Methods</b>: The thrombi of 91 patients were semi-automatically segmented on NCECT. A total of 1167 radiomic features (RFs) were extracted for each patient. Some clinical data (age, gender, cardiovascular risk factors, smoking or alcohol abuse, clot density and clot laterality) were also collected. <b>Results</b>: A LASSO regression analysis identified nine RFs with nonzero coefficients. A logistic regression model for FPE prediction was developed with nine RFs and eight clinical variables. A total of six RFs were found to be statistically associated with FPE. The clinical variables did not demonstrate a statistically significant association with the likelihood of achieving FPE (<i>p</i> > 0.05). The prediction of which patients are likely to achieve FPE obtained an AUC, accuracy, sensitivity and specificity of 0.890, 0.813, 0.815 and 0.811, respectively (<i>p</i> < 0.05). <b>Conclusions</b>: Radiomics can help identify patients who are more likely to achieve FPE with thromboaspiration.