Front Neurol. 2026 Sep 30;17:1777164. doi: 10.3389/fneur.2026.1777164. eCollection 2026.
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.
PMID:42876539 | PMC:PMC13661445 | DOI:10.3389/fneur.2026.1777164