ABSTRACT NUMBER: ESOC2026A1158 CLINICAL SCALE FOR PREDICTING FUTILE RECANALIZATION IN ISCHEMIC STROKE PATIENTS WITH A HISTORY OF CANCER AFTER MECHANICAL THROMBECTOMY

Abstract Background and aims To develop a predictive model for futile recanalization (FR) after mechanical thrombectomy(MT) in patients with acute ischemic stroke and history of cancer. Methods We conducted a retrospective analysis of prospectively included patients from the ARTISTA registry treated with MT(2021-2023). FR was defined as mRS>2 after MT, despite achieving successful recanalization(eTICI-score ≥2b). Univariate analysis was performed for variable screening, LASSO regression for predictor selection and multivariate logistic regression with internal validation. The final model was transformed into a clinical scoring system. Results Among 1,582 MT procedures performed, 203 patients(12.8%) had a history of cancer. The rate of FR was 36.5%, compared to 28.8% in patients without cancer(p=0.032). Predictive variables for FR were analyzed and transformed into a clinical risk scale which included:dyslipidemia[OR 2.44; 95%CI(1.08–5.71); p=0.035]; metastases[OR 9.65; 95%CI (2.69–43.06);p=0.001]; active chemotherapy [OR 5.50; 95%CI(1.02–50.01); p=0.076]; NIHSS [OR 1.10; 95%CI(1.04–1.17); p=0.002]; baseline mRS [OR 1.60; 95%CI(0.87–3.04); p=0.133]; neutrophil-to-lymphocyte ratio(NLR) [OR 1.07; 95%CI(1.01–1.15); p=0.028] and age [OR 1.03; 95%CI (0.98–1.08); p=0.227]. Model calibration and discrimination were adequate, as indicated by the Hosmer-Lemeshow test (p=0.732) and the ROC curve [AUC=0.82, 95% CI (0.75–0.88)]. Conclusions Patients with history of cancer have a higher risk of resulting in worse functional outcomes after MT. We present the first clinical risk score integrating oncological and clinical factors to predict FR in this population, which may facilitate more individualized and informed clinical decision-making. Conflict of interest The authors report no disclosures or conflicts of interest.