Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

Yu Sun; Eric Jou; Thanh N Nguyen; Mohammad Mofatteh; Qingjia Liang; Mohamad Abdalkader; Zile Yan; Mingzhu Feng; Xinyuan Li; Guilan Li; Lanzhu Luo; Yuzheng Lai; Shuiquan Yang; Sijie Zhou; Zhiming Xu; Xiaodong Cai; Yimin Chen

doi:10.3389/fnins.2023.1279366

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

Front Neurosci. 2023 Nov 28:17:1279366. doi: 10.3389/fnins.2023.1279366. eCollection 2023.

Authors

Yu Sun¹, Eric Jou², Thanh N Nguyen³, Mohammad Mofatteh⁴, Qingjia Liang^{1

5}, Mohamad Abdalkader⁶, Zile Yan¹, Mingzhu Feng¹, Xinyuan Li^{7

8}, Guilan Li¹, Lanzhu Luo¹, Yuzheng Lai⁹, Shuiquan Yang¹, Sijie Zhou¹⁰, Zhiming Xu^{11

12}, Xiaodong Cai^{13

14}, Yimin Chen^{1

15}

Affiliations

¹ Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, China.
² Kellogg College, University of Oxford, Oxford, United Kingdom.
³ Department of Neurology, Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
⁴ School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.
⁵ Department of Internal Medicine, Foshan Sanshui District People's Hospital, Foshan, China.
⁶ Department of Radiology, Boston University Chobanian & Avedsian School of Medicine, Boston, MA, United States.
⁷ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁸ Medical Intern, Foshan Sanshui District People's Hospital, Foshan, China.
⁹ Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, China.
¹⁰ Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, China.
¹¹ Advanced Stroke Center Management Committee, Foshan Sanshui District People's Hospital, Foshan, China.
¹² Dean Office, Foshan Sanshui District People's Hospital, Foshan, China.
¹³ Department of NeurologyThe Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
¹⁴ Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹⁵ Neuro International Collaboration (NIC), Foshan, China.

Abstract

Background and objectives: Endovascular thrombectomy (EVT) improves long-term outcomes and decreases mortality in ischemic stroke patients. However, a significant proportion of patients do not benefit from EVT recanalization, a phenomenon known as futile recanalization or reperfusion without functional independence (RFI). In this study, we aim to identify the major stroke risk factors and patient characteristics associated with RFI.

Methods: This is a retrospective cohort study of 297 consecutive patients with ischemic stroke who received EVT at three academic stroke centers in China from March 2019 to March 2022. Patient age, sex, modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS), Alberta stroke program early CT score (ASPECTS), time to treatment, risk factors and comorbidities associated with cerebrovascular diseases were collected, and potential associations with futile recanalization were assessed. RFI was successful reperfusion defined as modified thrombolysis in cerebral infarction (mTICI) ≥ 2b without functional independence at 90 days (mRS ≥ 3).

Results: Of the 297 initial patients assessed, 231 were included in the final analyses after the application of the inclusion and exclusion criteria. Patients were divided by those who had RFI (n = 124) versus no RFI (n = 107). Older age (OR 1.041, 95% CI 1.004 to 1.073; p = 0.010), chronic kidney disease (OR 4.399, 0.904-21.412; p = 0.067), and higher 24-h NIHSS (OR 1.284, 1.201-1.373; p < 0.001) were independent predictors of RFI. Conversely, an mTICI score of 3 was associated with a reduced likelihood of RFI (OR 0.402, 0.178-0.909; p = 0.029).

Conclusion: In conclusion, increased age, higher 24-h NIHSS and lack of an mTICI score of 3 were independently associated with RFI and have potential prognostic values in predicting patients that are less likely to respond to EVT recanalization therapy.

Keywords: NIHSS; endovascular thrombectomy; futile recanalization; patient outcome; prognosis; recanalization; stroke.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was supported by the Foshan Science and Technology Bureau (grant no. 2220001005022), the Medical Science and Technology Research Foundation of Guangdong Province (grant no. 20221027164016611), the Foshan 14th Five-Year Plan Key Discipline Foundation, China, the Guangdong provincial TCM Bureau Key Discipline Foundation, China.