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Updated: Oct 7, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Association between CHADS2, CHA2DS2-VASc, ATRIA, and Essen Stroke Risk Scores and Unsuccessful Recanalization after
Hyung Jun Kim1, Moo-Seok Park1, Joonsang Yoo2
1Department of Neurology, Seoul Hospital, College of Medicine, Ewha Woman's University, Seoul 07804, Korea.
Insights
Stroke risk scores like CHADS₂ predict unsuccessful recanalization after endovascular thrombectomy (EVT). These scores can help identify patients who may not benefit from EVT, guiding treatment decisions.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Established stroke risk scores (CHADS₂, CHA₂DS₂-VASc, ATRIA, Essen) are used for predicting vascular outcomes.
- The efficacy of these scores in predicting recanalization after endovascular thrombectomy (EVT) remains under investigation.
Purpose of the Study:
- To investigate the association between pre-admission stroke risk scores and the success of recanalization following EVT.
- To determine if existing stroke risk scores can predict unsuccessful recanalization in patients undergoing EVT.
Main Methods:
- A nationwide multicenter registry (SECRET) including 501 patients who underwent EVT was analyzed.
- Pre-admission stroke risk scores were identified for all included patients.
- Statistical analysis, including univariable analysis adjusted for body mass index, was performed to assess the association between risk scores and recanalization success.
Main Results:
- A total of 410 patients (81.8%) achieved successful recanalization (mTICI ≥ 2b).
- All investigated stroke risk scores were significantly associated with unsuccessful recanalization (p < 0.001 for CHADS₂ and Essen, p = 0.004 for CHA₂DS₂-VASc, p = 0.024 for ATRIA).
- The CHADS₂ score demonstrated the highest predictive value (AUC = 0.618), significantly outperforming the Essen score.
Conclusions:
- Pre-admission stroke risk scores are associated with unsuccessful recanalization after EVT.
- These scores may serve as valuable tools for predicting recanalization outcomes in stroke patients undergoing EVT.
Background:
The CHADS2, CHA2DS2-VASc, ATRIA, and Essen scores have been developed for predicting vascular outcomes in stroke patients. We investigated the association between these stroke risk scores and unsuccessful recanalization after endovascular thrombectomy (EVT).
Methods:
From the nationwide multicenter registry (Selection Criteria in Endovascular Thrombectomy and Thrombolytic therapy (SECRET)) (Clinicaltrials.gov NCT02964052), we consecutively included 501 patients who underwent EVT. We identified pre-admission stroke risk scores in each included patient.
Results:
Among 501 patients who underwent EVT, 410 (81.8%) patients achieved successful recanalization (mTICI ≥ 2b). Adjusting for body mass index and p < 0.1 in univariable analysis revealed the association between all stroke risk scores and unsuccessful recanalization (CHADS2 score: odds ratio (OR) 1.551, 95% confidence interval (CI) 1.198-2.009, p = 0.001; CHA2DS2VASc score: OR 1.269, 95% CI 1.080-1.492, p = 0.004; ATRIA score: OR 1.089, 95% CI 1.011-1.174, p = 0.024; and Essen score: OR 1.469, 95% CI 1.167-1.849, p = 0.001). The CHADS2 score had the highest AUC value and differed significantly only from the Essen score (AUC of CHADS2 score; 0.618, 95% CI 0.554-0.681).
Conclusion:
All stroke risk scores were associated with unsuccessful recanalization after EVT. Our study suggests that these stroke risk scores could be used to predict recanalization in stroke patients undergoing EVT.
