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Peer-reviewedCC BYFrontiers in neurology

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

  • Yangchun Wen1
  • Xi Liu1
  • Xiujing Liao2
  • Guanghong Zhong2
  • Hongli Gu2
  • Jia Zhang2
  • Ying Xie2
  1. 1Department of Neurology, Heyuan Hospital of Traditional Chinese Medicine , ,
  2. 2Heyuan People’s Hospital , , ,
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{wen2026predictors,
  title = {{Predictors of futile recanalization following endovascular therapy for acute anterior circulation large vessel occlusion stroke: a retrospective cohort study}},
  author = {Yangchun Wen and Xi Liu and Xiujing Liao and Guanghong Zhong and Hongli Gu and Jia Zhang and Ying Xie},
  journal = {Frontiers in neurology},
  year = {2026},
  month = sep,
  doi = {10.3389/fneur.2026.1777164},
  url = {https://europepmc.org/article/PMC/PMC13661445},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Predictors of futile recanalization following endovascular therapy for acute anterior circulation large vessel occlusion stroke: a retrospective cohort study
AU  - Yangchun Wen
AU  - Xi Liu
AU  - Xiujing Liao
AU  - Guanghong Zhong
AU  - Hongli Gu
AU  - Jia Zhang
AU  - Ying Xie
PY  - 2026
DA  - 2026/09/30
JO  - Frontiers in neurology
DO  - 10.3389/fneur.2026.1777164
UR  - https://europepmc.org/article/PMC/PMC13661445
AB  - 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.
SN  - 1664-2295
ER  -