Research Article Open Access
Volume 4 | Issue 2 | DOI: https://doi.org/10.33696/cardiology.4.043

The Use of CHA2DS2-VASc Score to Predict Functional Outcomes of Mechanical Thrombectomy

  • 1Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
  • 2University of Tennessee Medical Center Brain & Spine Institute, Knoxville, TN 37920, USA
  • 3University of Tennessee Medical Center Heart Lung Vascular Institute, Knoxville, TN 37920, USA
+ Affiliations - Affiliations

*Corresponding Author

James Livesay, jlivesay@utmck.edu

Received Date: July 24, 2023

Accepted Date: October 11, 2023


Background: Mechanical thrombectomy is widely used for revascularization of acute ischemic strokes from large vessel occlusions. Functional  outcomes following mechanical thrombectomy are typically assessed using the modified Rankin scale. CHA2DS2-VASc score is commonly used to estimate the stroke risk of patients with atrial fibrillation, but studies have verified its use in other various situations. Our study aimed to assess the utility of CHA2DS2-VASc score in predicting outcomes of patients undergoing mechanical thrombectomy.

Methods: We performed a single center retrospective study. Of patients with acute ischemic stroke who underwent mechanical thrombectomy for large vessel occlusion (n = 448). CHA2DS2-VASc score was calculated on each patient and the study population was grouped based on low-risk ≤ 2, intermediate risk 3-4 and high-risk ≥ 5. Association between CHA2DS2-VASc score and 90-day modified Rankin score as well as in-hospital, 30-day, and 1-year mortality was evaluated and compared between the three groups.

Results: A total of 312 patients met criteria for the study. Patients in the high-risk CHA2DS2-VASc score had a significantly higher modified Rankin score (4.48) when compared to low (2.57) and intermediate (3.82) risk groups. Higher CHA2DS2-VASc scores were also associated with a significantly higher in-hospital, 30-day, and one year mortality.

Conclusion: CHA2DS2-VASc score, a simple bed-side tool, can predict higher mortality and worse functional outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy for large vessel occlusions.


Mechanical thrombectomy, CHA2DS2-VASc Score, Ischemic stroke, Modified Rankin Score


Mechanical thrombectomy has been widely accepted as the gold standard therapy for acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO) [1,2]. Multiple large clinical trials have demonstrated that endovascular therapy is safe, effective, and significantly improves long-term functional outcomes following an AIS when compared to medical therapy [3-8]. Functional outcome, independence, and disability are commonly measured 90 days after mechanical thrombectomy using the modified Rankin score (mRS). Scoring systems to predict functional outcomes and mortality following an AIS have been well established in the literature [9-16]. Additionally, with the increasing use of mechanical thrombectomy, experts have also developed scores to predict mechanical thrombectomy outcomes. While initial scoring systems focus primarily on pre-thrombectomy radiologic findings, more recent ones have also included clinical parameters to predict post-procedural as well as functional outcomes. Examples of such scores include GADIS (Gender, Age, Diabetes mellitus history, Infarct volume, and current Smoker) and the THRIVE (Totaled Health Risks in Vascular Events) scores. These scores have demonstrated that chronic medical comorbidities can significantly influence short-term post-thrombectomy prognosis and functional outcome [17,18]. Many proceduralist utilize these scores as helpful adjuncts to neuroimaging findings in predicting thrombectomy outcomes [19]. However, to our knowledge, there are no studies using an established and easily obtainable scoring system such as the CHA2DS2-VASc score to predict functional outcomes following mechanical thrombectomy.

Recent studies have shown that the CHA2DS2-VASc score can be used to predict various outcomes beyond embolic stroke risk in patients with atrial fibrillation [20-24]. Furthermore, the CHA2DS2-VASc score has been shown to predict prognosis after stroke in patients with and without atrial fibrillation [25,26]. The CHA2DS2-VASc score includes many risk factors that lead to poor functional independence (an elevated mRS) following an AIS including hypertension, diabetes mellitus, and older age [27-30]. We therefore aimed to assess the utility of the CHA2DS2-VASc score in predicting short-term functional outcomes in patients who underwent mechanical thrombectomy for the treatment of LVO related AIS.


This is a single-center, nonrandomized, retrospective observational study performed at the University of Tennessee Medical Center, in Knoxville, Tennessee. The study was approved by the institutional review board (IRB) and conducted in compliance with the ethical standards of the responsible institution on human subjects as well as the Helsinki Declaration.

The study included patients with radiographic evidence of acute thromboembolic strokes who underwent mechanical thrombectomy. Charts were reviewed to calculate a CHA2DS2-VASc score and assess in-hospital, 30-day, and one-year mortality. Patients were divided into three groups based on the CHA2DS2-VASc scores as low-risk ≤ 2, intermediate risk 3-4, and high-risk ≥ 5. All patients between January 2018 and December 2020 were included in the study if they were ≥ 18 years of age, had an acute ischemic stroke confirmed by imaging, and had undergone mechanical thrombectomy.

 A total of 448 patients were reviewed of which 312 patients had a confirmed thromboembolic stroke and underwent mechanical thrombectomy were selected and included in the study. Basic demographics, past medical history, use of thrombolytics, ejection fraction, stroke location, and degree of carotid stenosis were collected and analyzed for each patient. One-way ANOVA test was used for continuous variables and chi-square test was used for categorical variables. CHA2DS2-VASc scores were calculated on all the patients. The primary endpoint was the patient’s modified-Rankin Score at 90-days. Secondary endpoints included mortality at 30-days and one-year mortality [27-30].


A total of 312 patients with imaging confirmed thromboembolic stroke who underwent mechanical thrombectomy were included in this study. Patients were divided into three groups based on their calculated CHA2DS2-VASc score as either low-risk ≤ 2 (n = 97), intermediate risk 3-4 (n = 144), or high-risk ≥ 5 (n = 71) groups.

The baseline characteristics of the patient population are described in Table 1. The mean age of our study population was 70 years of age. One hundred and forty-nine patients were male (47%) and 163 were female (53%). A total of 129 patients (41%) received thrombolytics prior to undergoing mechanical thrombectomy. As expected, the primary stroke location was the middle cerebral artery in the majority (65%, n = 202).

Table 1. Baseline characteristics of patients.


Low CHA2DS2-VASc Score

≤ 2

(n = 97)

Intermediate CHA2DS2-VASc Score 3-4

 (n = 144)

High CHA2DS2-VASc Score ≥ 5

(n = 71)

Age (Yrs)

59.4 ± 12.29

72.15 ± 11.98

80.55 ± 7.41



60 (61.86%)

63 (43.75%)

26 (36.62%)


37 (38.14%)

81 (56.25%)

45 (63.38%)

Medical history

 Diabetes Mellitus

6 (6.19%)

40 (27.77%)

37 (52.11%)


49 (50.51%)

117 (81.25%)

66 (92.95%)

 Chronic systolic heart failure

5 (5.15%)

15 (10.42%)

14 (19.72%)

 Chronic diastolic heart failure

21 (21.65%)

50 (34.72%)

35 (49.29%)

 Previous Stroke/TIA

0 (0%)

21 (14.58%)

40 (56.33%)

 Coronary artery disease

2 (2.1%)

36 (25%)

28 (39.44%)


27 (27.83%)

71 (49.30%)

45 (63.38%)

 Peripheral arterial disease

1 (1.03%)

7 (4.86%)

10 (14.08%)

 Chronic kidney disease

6 (6.19%)

16 (11.11%)

10 (14.08%)

 Atrial fibrillation

15 (15.46%)

53 (36.81%)

33 (46.48%)


49 (50.51%)

55 (38.19%)

18 (25.35%)

 Obstructive sleep apnea

4 (4.12%)

7 (4.86%)

2 (2.82%)

 Patent foramen ovale

6 (6.19%)

2 (1.39%)

1 (1.41%)

Ejection fraction (EF)

58.2 ± 9.81

56.68 ± 11.99

53.87 ± 14.52

BMI (kg/m2)

27.35 ± 5.45

28.38 ± 5.94

27.95 ± 6.43

tPA given

41 (42.27%)

61 (42.36%)

27 (38.02%)

Stroke location






65 (67.01%)

90 (62.5%)

47 (66.20%)


2 (2.1%)

5 (3.47%)

2 (2.82%)


5 (5.15%)

13 (9.03%)

6 (8.45%)


3 (3.1%)

8 (5.55%)

6 (8.45%)


3 (3.1%)





2 (1.39%)


 Multiple vessels

15 (15.46%)

26 (18.05%)

10 (14.08%)

Degree of carotid stenosis


55 (56.70%)

79 (54.86%)

28 (39.44%)


7 (7.22%)

16 (11.11%)

12 (16.90%)


2 (2.1%)

6 (4.17%)

15 (21.13%)


8 (8.25%)

13 (9.03%)

4 (5.63%)

 Totally occluded

25 (25.77%)

30 (20.83%)

12 (16.90%)

Abbreviations: TIA: Transient Ischemic Attack; BMI: Body Mass Index; tPA: Tissue Plasminogen Activator; ACA: Anterior Cerebral Artery; MCA: Middle Cerebral Artery; PCA: Posterior Cerebral Artery; ICA: Internal Carotid Artery.

Variables are expressed as no (%) or mean ± standard deviation.

Patients in the high-risk group had a higher 90-day mRS (4.48) when compared to those patients in the intermediate (mRS 3.82) or low-risk groups (mRS = 2.57). This difference was statistically significant between the high-risk and low-risk groups (p-value <0.0001) as well as between intermediate and low-risk groups (p-value <0.001) (Figure 1). There was no statistically significant difference between the intermediate and high-risk groups (p-value 0.075) (Figure 1). In-hospital and 30-day mortality was higher in patients in the intermediate risk group (28.17%) and high-risk group (31.94%) when compared to those patients in the low-risk group (16.49%). This difference was statistically significant (p-value = 0007 and 0.07 respectively; Figure 2 and Table 2). One-year mortality was also significantly higher in the high-risk group (12.68%) compared with the intermediate (3.46%, p-value = 0.01) and low-risk groups (4.12%, p-value = 0.04) (Figure 2 and Table 2).

Figure 1. Comparing modified Rankin scores for patients with low, intermediate, and high risk CHA2DS2-VASc Score groups.

Figure 2. Comparing in-hospital and one year mortality for patients with low, intermediate, and high risk CHA2DS2-VASc Score groups.

Table 2. Clinical outcomes of patients with low, intermediate, and high risk CHA2DS2-VASc Scores.

Clinical Outcomes

Low CHA2DS2-VASc Score

≤ 2

(n = 97)

Intermediate CHA2DS2-VASc Score 3-4

 (n = 144)

High CHA2DS2-VASc Score ≥ 5

(n = 71)

P Value




16 (16.49%)

46 (31.94%)

20 (28.17)


 1 Year

4 (4.12%)

5 (3.47%)

9 (12.68%)


Modified Rankin Score (mRS)

2.57 ± 2.21

3.82 ± 2.06

4.48 ± 1.82



The management of AIS secondary to LVO has greatly evolved with the utilization of mechanical thrombectomy. Studies have demonstrated that patients undergoing endovascular therapy have better outcomes and greater rates of functional independence compared to patients treated with medical therapy alone [2-7,31]. Studies have also shown that mechanical thrombectomy provides benefit up to 24 hours after a LVO related AIS [19,31]. Importantly, patients presenting with high pre-stoke functional disability and elevated pre-stroke mRS have similar clinical outcomes with mechanical thrombectomy compared to patients with pre-stroke independence [32,33]. Despite the known outcome benefits of mechanical thrombectomy, interventional proceduralist must utilize both clinical judgement and neuroimaging findings to predict post-thrombectomy functional outcomes and mortality. To help with this prediction, scoring systems have been developed to use in the clinical setting prior to performing mechanical thrombectomy. Studies have identified various neuroimaging findings on both computerized tomography (CT) scan and magnetic resonance imaging (MRI), that can functional outcome and response to endovascular therapy [34-43]. While initially developed to determine stroke severity and predict functional outcome following an AIS, the Alberta Stroke Program Early CT Score (ASPECTS) has also been used to predict outcomes following mechanical thrombectomy [35-39]. More recently, in addition to neuroimaging parameters, outcome prediction scores have also included clinical parameters [18,44-46]. The TICI-ASPECTS-glucose (TAG) score, which includes two neuroimaging scores (TICI and ASPECTS) and glucose level, has been shown to predict symptomatic intracranial hemorrhage in patients receiving endovascular therapy [45]. The GADIS score combines cerebral infarct volume on MRI following endovascular therapy with gender, age, diabetes history, and current smoking status to help in early short-term prognostication [18,46]. However, experts have criticized certain aspects of the GADIS score, specifically the need for a post-intervention MRI [47]. The THRIVE score was one of the first scoring systems to use clinical data to predict functional outcome in patients presenting with acute basal artery occlusions treated with mechanical thrombectomy [17]. Patients with high THRIVE scores following thrombectomy, including those with hypertension, atrial fibrillation, hyperglycemia, elevated NIH scores, and older age, are at increased risk for poor functional outcomes and all-cause mortality [17]. Despite the recent advancements in endovascular therapy, scoring systems that focus on easily obtained clinical data to predict functional outcomes following mechanical thrombectomy are limited. The goal of our study was to determine the utility of the CHA2DS2-VASc score in predicting functional outcomes of patients with LVO related AIS undergoing mechanical thrombectomy.

Our decision to use the CHA2DS2-VASc score to predict functional outcomes following mechanical thrombectomy was based on three main factors. First, the CHA2DS2-VASc score can be easily calculated from a quick review of past medical history. Second, studies have established the validity of the CHA2DS2-VASc score to predict stroke as well as poor cardiovascular outcomes in both patients with and without atrial fibrillation [22-26]. Lastly, the CHA2DS2-VASc score includes some of the same risk factors – hypertension older age, and diabetes - that lead to poor functional outcomes (such as elevated mRS) following an AIS [27-30]. In our cohort of 312 patients presenting with LVO related to AIS, the relationship between CHA2DS2-VASc score and mRS were directly proportional. Thus, patients with a higher CHA2DS2-VASc score prior to mechanical thrombectomy were more likely to have higher mRS at 90 days post-thrombectomy and therefore, worse functional independence. At 90 days following mechanical thrombectomy, patients with a CHA2DS2-VASc score of 5 or greater were more likely to have moderate to severe disability, required walking assistance, and were unable to attend to bodily needs without assistance compared to patients with lower CHA2DS2-VASc scores. Furthermore, patients with pre-thrombectomy CHA2DS2-VASc scores ≥ 5 are at higher risk of 1 year mortality following endovascular therapy.

As previously discussed, all patients presenting with LVO related AIS benefit from mechanical thrombectomy including those with multiple comorbidities and pre-stroke dependence [32,33]. Therefore, the purpose of our study was not to discourage interventional proceduralist from performing mechanical thrombectomy in patients with high CHA2DS2-VASc scores. Rather, this study focused on using a well-known, simple scoring system to predict poor functional outcomes in patients undergoing mechanical thrombectomy and assist providers with post-procedural care planning. For example, providers can plan for the possibility of prolonged hospitalizations and more intensive rehabilitation in patients with elevated pre-thrombectomy CHA2DS2-VASc scores. Furthermore, proceduralists can have important conversations with patients and their families regarding their expectations about functional outcomes following mechanical thrombectomy. While not addressed in this study, another potential use of estimating pre-procedural CHA2DS2-VASc score is procedural planning and predicting risk of mechanical thrombectomy failure. Given that the CHA2DS2-VASc score includes many of the same risk factors that lead to thrombectomy failure such as pre-existing atherosclerosis, it could potentially be used to identify patients who are at higher risk of failure [48-55]. However, additional research is needed to further investigate this hypothesis.

Our study aimed to assess the utility of the CHA2DS2-VASc score in predicting outcomes in patients that undergo mechanical thrombectomy for acute ischemic stroke. There are a plethora of studies demonstrating the benefits of rapid cerebral reperfusion particularly with the use of mechanical thrombectomy. Our study suggests that the higher the CHA2DS2-VASc score, higher the modified Rankin score at 90-days, with similar linear relationship with in-hospital, 30-day, and one-year mortality in patients with higher CHA2DS2-VASc score.


The main limitation of our study was data collection in a retrospective manner at a single center. In addition, only patients with a 90-day mRS and at least one year follow-up was included in this study. A randomized controlled study would alleviate these limitations.


CHA2DS2-VASc score is a simple tool which can quickly be assessed to predict patient outcomes following mechanical thrombectomy. Using this easy to calculate bedside pre-procedural score can help assess patient outcomes and provide answers regarding family’s expectations. The CHA2DS2-VASc score can be useful in predicting functional outcomes in patients undergoing mechanical thrombectomy.


1. Boisseau W, Escalard S, Fahed R, Lapergue B, Smajda S, Maier B, et al. Direct aspiration stroke thrombectomy: a comprehensive review. J Neurointerv Surg. 2020;12(11):1099-106.

2. McCarthy DJ, Diaz A, Sheinberg DL, Snelling B, Luther EM, Chen SH, et al. Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis. ScientificWorldJournal. 2019;2019:7403104.

3. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018;378(8):708-18.

4. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11-20.

5. Fransen PS, Beumer D, Berkhemer OA, van den Berg LA, Lingsma H, van der Lugt A, et al. MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials. 2014;15:343.

6. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019-30.

7. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296-306.

8. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285-95.

9. Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, et al. Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol. 2016;79(1):76-89.

10. Carbone F, Busto G, Padroni M, Bernardoni A, Colagrande S, Dallegri F, et al. Radiologic Cerebral Reperfusion at 24 h Predicts Good Clinical Outcome. Transl Stroke Res. 2019;10(2):178-88.

11. De Marchis GM, Dankowski T, König IR, Fladt J, Fluri F, Gensicke H, et al. A novel biomarker-based prognostic score in acute ischemic stroke: The CoRisk score. Neurology. 2019;92(13):e1517-e25.

12. Drozdowska BA, Singh S, Quinn TJ. Thinking About the Future: A Review of Prognostic Scales Used in Acute Stroke. Front Neurol. 2019;10:274.

13. Kwok CS, Potter JF, Dalton G, George A, Metcalf AK, Ngeh J, et al. The SOAR stroke score predicts inpatient and 7-day mortality in acute stroke. Stroke. 2013;44(7):2010-2.

14. Ntaios G, Faouzi M, Ferrari J, Lang W, Vemmos K, Michel P. An integer-based score to predict functional outcome in acute ischemic stroke: the ASTRAL score. Neurology. 2012;78(24):1916-22.

15. O'Donnell MJ, Fang J, D'Uva C, Saposnik G, Gould L, McGrath E, et al. The PLAN score: a bedside prediction rule for death and severe disability following acute ischemic stroke. Arch Intern Med. 2012;172(20):1548-56.

16. Saposnik G, Fang J, Kapral MK, Tu JV, Mamdani M, Austin P, et al. The iScore predicts effectiveness of thrombolytic therapy for acute ischemic stroke. Stroke. 2012;43(5):1315-22.

17. Chen B, Yang L, Hang J, You S, Li J, Li X, et al. Predictive value of the THRIVE score for outcome in patients with acute basilar artery occlusion treated with thrombectomy. Brain Behav. 2019;9(10):e01418.

18. O'Connor KP, Hathidara MY, Danala G, Xu C, McCoy TM, Sidorov EV, et al. Predicting Clinical Outcome After Mechanical Thrombectomy: The GADIS (Gender, Age, Diabetes Mellitus History, Infarct Volume, and Current Smoker [corrected]) Score. World Neurosurg. 2020;134:e1130-e42.

19. Teo YH, Lim I, Tseng FS, Teo YN, Kow CS, Ng ZHC, et al. Predicting Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy with Machine Learning : A Systematic Review and Meta-analysis. Clin Neuroradiol. 2021;31(4):1121-30.

20. Orvin K, Levi A, Landes U, Bental T, Sagie A, Shapira Y, et al. Usefulness of the CHA2DS2-VASc Score to Predict Outcome in Patients Who Underwent Transcatheter Aortic Valve Implantation. The American Journal of Cardiology. 2018;121(2):241-8.

21. Parodi G, Scudiero F, Citro R, Silverio A, Bellandi B, Zito C, et al. Risk Stratification Using the CHA2DS2‐VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network. Journal of the American Heart Association. 2017;6(9):e006065.

22. Tahir H, Livesay J, Fogelson B, Coombes T, Patel C, Baljepally R. Use of the CHA(2)DS(2)-VASc score in assessing transradial approach failure. Cardiovasc Revasc Med. 2021.

23. Ünal S, Açar B, Yayla Ç, Balci MM, Ertem A, Kara M, et al. Importance and usage of the CHA2DS2-VASc score in predicting acute stent thrombosis. Coron Artery Dis. 2016;27(6):478-82.

24. Tahir H, Sarwar U, Hussain A, Awan MU, Ahmad S, et al. (2021) Use of CHA2DS2-VASc Score in Patients without Atrial Fibrillation: Review of Literature. J Card Cardi Sur. 1:05.

25. Yang HJ, Wang GJ, Shuai W, Shen CJ, Kong B, Huang H. The Value of the CHADS(2) and CHA(2)DS(2)-VASc Score for Predicting the Prognosis in Lacunar Stroke with or without Atrial Fibrillation Patients. J Stroke Cerebrovasc Dis. 2019;28(11):104143.

26. Kusznir Vitturi B, José Gagliardi R. Use of CHADS(2) and CHA(2)DS(2)-VASc scores to predict prognosis after stroke. Rev Neurol (Paris). 2020;176(1-2):85-91.

27. Jiang S, Fei A, Peng Y, Zhang J, Lu YR, Wang HR, et al. Predictors of Outcome and Hemorrhage in Patients Undergoing Endovascular Therapy with Solitaire Stent for Acute Ischemic Stroke. PLoS One. 2015;10(12):e0144452.

28. Yang M, Lu T, Weng B, He Y, Yang H. Association Between Blood Pressure Variability and Short-Term Outcome After Intra-arterial Thrombectomy in Acute Stroke Patients With Large-Vessel Occlusion. Front Neurol. 2020;11:604437.

29. Tziomalos K, Spanou M, Bouziana SD, Papadopoulou M, Giampatzis V, Kostaki S, et al. Type 2 diabetes is associated with a worse functional outcome of ischemic stroke. World J Diabetes. 2014;5(6):939-44.

30. Esmael A, Fathi W, Abdelbadie M, Tharwat Mohammed El-sayed N, Ghoneim M, Abdelnaby A. Proper timing of control of hypertension and outcome in acute spontaneous intracerebral hemorrhage. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2020;56(1):68.

31. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. New England Journal of Medicine. 2017;378(1):11-21.

32. Salwi S, Cutting S, Salgado AD, Espaillat K, Fusco MR, Froehler MT, et al. Mechanical Thrombectomy in Ischemic Stroke Patients with Severe Pre-Stroke Disability. J Stroke Cerebrovasc Dis. 2020;29(8):104952.

33. Goldhoorn RB, Verhagen M, Dippel DWJ, van der Lugt A, Lingsma HF, Roos Y, et al. Safety and Outcome of Endovascular Treatment in Prestroke-Dependent Patients. Stroke. 2018;49(10):2406-14.

34. Bae S, Ahn SS, Kim BM, Kim DJ, Kim YD, Nam HS, et al. Hyperattenuating lesions after mechanical thrombectomy in acute ischaemic stroke: factors predicting symptomatic haemorrhage and clinical outcomes. Clin Radiol. 2021;76(1):80.e15-80.e23.

35. Diestro JDB, Dmytriw AA, Broocks G, Chen K, Hirsch JA, Kemmling A, et al. Endovascular Thrombectomy for Low ASPECTS Large Vessel Occlusion Ischemic Stroke: A Systematic Review and Meta-Analysis. Can J Neurol Sci. 2020;47(5):612-9.

36. Leker RR, Honig A, Filioglo A, Simaan N, Gomori JM, Cohen JE. Post-stroke ASPECTS predicts outcome after thrombectomy. Neuroradiology. 2021;63(5):769-75.

37. Manceau PF, Soize S, Gawlitza M, Fabre G, Bakchine S, Durot C, et al. Is there a benefit of mechanical thrombectomy in patients with large stroke (DWI-ASPECTS ≤ 5)? Eur J Neurol. 2018;25(1):105-10.

38. Olivot JM, Albucher JF, Guenego A, Thalamas C, Mlynash M, Rousseau V, et al. Mismatch Profile Influences Outcome After Mechanical Thrombectomy. Stroke. 2021;52(1):232-40.

39. Phan K, Saleh S, Dmytriw AA, Maingard J, Barras C, Hirsch JA, et al. Influence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis. J Neurointerv Surg. 2019;11(7):664-9.

40. Sarioglu O, Sarioglu FC, Capar AE, Sokmez DFB, Topkaya P, Belet U. The role of CT texture analysis in predicting the clinical outcomes of acute ischemic stroke patients undergoing mechanical thrombectomy. Eur Radiol. 2021;31(8):6105-15.

41. Yu KW, Lin CJ, Luo CB, Lin YY, Guo WY, Chang FC, et al. Single-phase computed tomography angiography sufficiently predicts outcomes after mechanical thrombectomy. J Chin Med Assoc. 2020;83(5):478-83.

42. Yeo LLL, Paliwal PR, Wakerley B, Khoo CM, Teoh HL, Ahmad A, et al. External Validation of the Boston Acute Stroke Imaging Scale and M1-BASIS in Thrombolyzed Patients. Stroke. 2014;45(10):2942-7.

43. Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, et al. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol. 2012;11(10):860-7.

44. Liggins JT, Yoo AJ, Mishra NK, Wheeler HM, Straka M, Leslie-Mazwi TM, et al. A score based on age and DWI volume predicts poor outcome following endovascular treatment for acute ischemic stroke. Int J Stroke. 2015;10(5):705-9.

45. Montalvo M, Mistry E, Chang AD, Yakhkind A, Dakay K, Azher I, et al. Predicting symptomatic intracranial haemorrhage after mechanical thrombectomy: the TAG score. J Neurol Neurosurg Psychiatry. 2019;90(12):1370-4.

46. Hathidara MY, O'Connor KP, Xu C, Zheng B, Ray B. In Reply to the Letter to the Editor Regarding "Predicting Clinical Outcome After Mechanical Thrombectomy: The GADIS (Gender, Age, Diabetes Mellitus History, Infarct Volume, and Sex) Score". World Neurosurg. 2020;138:589-90.

47. Chalos V, Venema E, Lingsma HF, Dippel DWJ. Letter to the Editor Regarding "Predicting Clinical Outcome After Mechanical Thrombectomy: The GADIS (Gender, Age, Diabetes Mellitus History, Infarct Volume, and Sex) Score". World Neurosurg. 2020;138:587-8.

48. Balami JS, White PM, McMeekin PJ, Ford GA, Buchan AM. Complications of endovascular treatment for acute ischemic stroke: Prevention and management. Int J Stroke. 2018;13(4):348-61.

49. Bang OY. Intracranial atherosclerosis: current understanding and perspectives. J Stroke. 2014;16(1):27-35.

50. Heider DM, Simgen A, Wagenpfeil G, Dietrich P, Yilmaz U, Mühl-Benninghaus R, et al. Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke. Neurol Sci. 2020;41(6):1547-55.

51. Holmstedt CA, Turan TN, Chimowitz MI. Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol. 2013;12(11):1106-14.

52. Kaesmacher J, Gralla J, Mosimann PJ, Zibold F, Heldner MR, Piechowiak E, et al. Reasons for Reperfusion Failures in Stent-Retriever-Based Thrombectomy: Registry Analysis and Proposal of a Classification System. AJNR Am J Neuroradiol. 2018;39(10):1848-53.

53. Kaymaz ZO, Nikoubashman O, Brockmann MA, Wiesmann M, Brockmann C. Influence of carotid tortuosity on internal carotid artery access time in the treatment of acute ischemic stroke. Interv Neuroradiol. 2017;23(6):583-8.

54. Leischner H, Flottmann F, Hanning U, Broocks G, Faizy TD, Deb-Chatterji M, et al. Reasons for failed endovascular recanalization attempts in stroke patients. J Neurointerv Surg. 2019;11(5):439-42.

55. Yeo LLL, Bhogal P, Gopinathan A, Cunli Y, Tan B, Andersson T. Why Does Mechanical Thrombectomy in Large Vessel Occlusion Sometimes Fail? : A Review of the Literature. Clin Neuroradiol. 2019;29(3):401-14.

Author Information X