Consecutive EVT patients for anterior circulation large vessel occlusion strokes were identified from 2016 to 2021 at a Comprehensive Stroke Center, and clinical information was recorded. FR was defined as a 90-day modified Rankin Scale (mRS) of 4 or greater despite achieving modified thrombolysis in cerebral infarction (mTICI) score 2b or greater. Multivariable regression analyses were used to identify independent risk factors for FR, and a scoring system was constructed.

619 patients were identified, and 483 patients with successful recanalization and available 90-day follow-up data were analyzed. Overall, FR was observed in 46.5% of patients. From a randomly selected training cohort (n=357), individual risk factors for FR were identified and used to construct the 10-point BAND score: baseline disability (1 point: baseline mRS ≥ 2), age (1 point: 60-69 years, 2 points: 70-79 years, 3 points: 80-84 years, 4 points: 85 years or older), NIHSS (2 points: 13-17, 3 points: 18-22, and 4 points: 23 or higher), and delay from last known normal (1 point: ≥6 hours). The BAND score achieved good predictability of FR with an area under the receiver-operating characteristic curve of 0.80 in our training cohort and 0.78 in our validation cohort. 88.2% of the total and 90.2% of patients 80 years or older with BAND ≥7 had a 90-day mRS of 4 or greater despite successful EVT recanalization.

The BAND score is a simple clinical scoring system for prediction of FR, and it has potential to serve as a valuable triage tool for physicians in a real-world setting.