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

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.

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.

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.

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.