A prediction model for functional outcome following rescue therapy in patients with acute ischemic stroke undergoing endovascular treatment

Abstract

Abstract Objective To evaluate the association between key preoperative and intraoperative factors and 90-day functional outcomes in acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT) with rescue therapy, and to establish a prognostic model for estimating 90-day functional outcomes. Methods We retrospectively enrolled AIS patients with EVT plus rescue therapy from January 2018 to December 2024. The primary endpoint was a 90-day modified Rankin Scale (mRS) score >2. Logistic regression identified predictors incorporated into a nomogram. Model performance was assessed with receiver operating characteristic (ROC) curves, the Hosmer–Lemeshow test, and decision curve analysis (DCA). Bootstrap resampling and 10-fold cross-validation assessed robustness. Results In total, 445 individuals were analyzed (training: 312; validation: 133). Multivariable analysis identified glycated hemoglobin (HbA1c; OR = 1.345, 95% CI: 1.145–1.608, p < 0.001), baseline National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.084, 95% CI: 1.047–1.127, p < 0.001), onset-to-puncture time (OPT; OR = 1.000, 95% CI: 1.000–1.000, p = 0.003), and puncture-to-reperfusion time (PRT; OR = 1.008, 95% CI: 1.001–1.015, p = 0.026) as independent predictors. The value of the area under the ROC curve (AUC) was 0.741 in the training cohort and 0.781 in the validation cohort. Calibration was adequate (Hosmer–Lemeshow p > 0.05 in both cohorts), and DCA demonstrated consistent clinical benefit. Bootstrap and cross-validation confirmed model reliability. Conclusion Our model integrating HbA1c, NIHSS, OPT, PRT, and refractory thrombectomy demonstrated acceptable performance in predicting 90-day outcomes after rescue therapy. However, as a development-phase model, its clinical applicability should be interpreted with caution.