Predictors of futile recanalization following endovascular therapy for acute anterior circulation large vessel occlusion stroke: a retrospective cohort study.

BACKGROUND

Endovascular therapy (EVT) is effective for acute anterior circulation large vessel occlusion (LVO), yet futile recanalization remains common. Identifying its predictors is essential to optimize patient selection.

METHODS

This retrospective cohort study included 311 patients with anterior circulation LVO who underwent successful EVT. Patients were divided into an effective recanalization group (90-day modified Rankin Scale (mRS) score ≤ 2, n = 150) and a futile recanalization group (mRS > 2, n = 161). Clinical, imaging, and procedural variables were compared. Multivariate logistic regression was used to identify independent predictors, and a predictive model was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS

Baseline comparisons between the two groups showed significant differences in age, sex, atrial fibrillation, stress hyperglycemia ratio (SHR), C-reactive protein, admission National Institutes of Health Stroke Scale (NIHSS) score, diffusion-weighted imaging (DWI) infarct volume, DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS) score, number of procedure attempts, and procedure time. Univariate logistic regression and multivariate logistic regression identified admission NIHSS score (OR = 1.381, 95% CI: 1.113-1.713, p = 0.003), DWI infarct volume (OR = 1.057, 95% CI: 1.025-1.090, p < 0.001), DWI-ASPECT score (OR = 69.240, 95% CI: 9.819-488.254, p < 0.001), procedure time (OR = 1.011, 95% CI: 1.005-1.018, p < 0.001), and SHR (OR = 3.447, 95% CI: 1.302-9.129, p = 0.013) as independent predictors of futile recanalization. A combined model incorporating these five predictors achieved an area under the curve (AUC) of 0.815 (sensitivity: 0.789, specificity: 0.787, Youden index: 0.576).

CONCLUSION

Admission NIHSS score, SHR, DWI infarct volume, DWI-ASPECT score, and procedure time are independent predictors of futile recanalization after EVT for anterior circulation LVO stroke. Higher NIHSS score, elevated SHR, larger infarct volume, lower DWI-ASPECT score, and prolonged procedure time increase the risk of poor functional outcome despite successful reperfusion.