Prognostic factors for futile recanalization in acute anterior ischemic stroke patients

Prognostic factors for futile recanalization in acute anterior ischemic stroke patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prognostic factors for futile recanalization in acute anterior ischemic stroke patients Shao-Fen Zhan, Yi-Han Weng, Niu-Niu Zhang, Yi-Cheng Liang, Xin-Tong Liu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4461148/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: More than half of the patients who underwent endovascular treatment for reperfusion had a poor prognosis. Our study aimed to investigate the factors associated with futile reperfusion following endovascular treatment in patients with acute ischemic stroke. Methods: This study conducted a postoperative analysis at Guangdong Province Second People's Hospital, focusing on patients with anterior circulation large-vessel occlusion who underwent endovascular treatment or a combination of intravenous thrombolysis from June 2019 to October 2023. Futile recanalization was determined based on a modified Rankin score of 3-6 at 90 days post-treatment. The researchers utilized multifactorial logistic regression to identify factors linked to futile recanalization following reperfusion in patients. Results: A total of 120 patients were enrolled, amongst which 52 patients (43.3%) had FR. After adjusting for confounders, the discharge NIHSS score, as a continuous variable, was associated with futile recanalization (per 1 score: aOR: 7.30,95%CI: 2.176-24.491, P=0.001), indicating an increased risk, hemorrhagic transformation was also associated with higher futile recanalization risk(aOR:8.556,95%CI: 11.038-70.549, P=0.046). Conclusion: In patients with large anterior circulation stroke, our findings suggest that the discharge INHSS score and hemorrhagic transformation are risk factors for FR. Futile recanalization FR Acute anterior ischemic stroke Endovascular therapy Introduction Endovascular therapy has become the standard treatment for patients with large vessel occlusion (LVO) stroke due to advancements in thrombolysis techniques and equipment( 1 ), as well as the positive outcomes seen in clinical studies of EVT (endovascular therapy)( 2 – 6 ). Futile recanalization was described as a poor clinical outcome despite successful revascularization (mTICI of 2b or c) following endovascular therapy. Nearly half of patients with anterior circulation occlusion (32.4–56.7%) experienced futile recanalization after undergoing endovascular treatment( 7 ). Large vessel occlusion without timely recanalization poses a significant risk, while recanalization can also lead to reperfusion damage, including factors such as microcirculatory disorders, inflammation( 8 ), and collateral circulation( 9 ). Identifying factors associated with predicting futile recanalization can help in selecting patients who may benefit more from Endovascular Therapy (EVT). Additionally, neurointerventionalists can tailor treatment programs based on individual patient factors. Therefore, conducting relevant clinical studies is valuable and significant for patients. This study aims to investigate factors linked to futile recanalization following endovascular treatment for acute ischemic stroke in the anterior circulation, with the goal of identifying patients who are more likely to benefit from EVT. Methods Study subjects This postoperative study analyzed patients with acute anterior circulation large vessel occlusion who underwent endovascular therapy or a combination of endovascular therapy and intravenous thrombolysis at the Second People's Hospital of Guangdong Province from June 2019 to October 2023. The study was approved by the Ethics Committee of the Second People's Hospital of Guangdong Province. The selection criteria were as follows: ( 1 )age over 18 years old; ( 2 )confirmed through CT or MR imaging to have acute circulation occlusion without cerebral hemorrhage; ( 3 )achieving successful recanalization (final mTICI 2b or 3) after treatment; ( 4 )absence of traumatic brain injury, cerebral hemorrhage, or other cerebral diseases within 6 months, ( 5 ) functional independence (a mRS score of 0–1) before stroke; ( 6 )imaging indicating acute anterior circulation occlusion (internal carotid artery (ICA) and/or middle cerebral artery (MCA) M1 or proximal M2); ( 7 )ability to cooperate with research requirements and provide informed consent; ( 8 )blood tests within 24 hours post-treatment; ( 9 )a 90-day follow-up mRS score assessment. The exclusion criteria were as follows: ( 1 ) occlusion of posterior; ( 2 ) Patients with myasthenia gravis, hypokalemic periodic paralysis, and other symptoms may be caused by non-cerebral infarction; ( 3 )failed recanalization; ( 4 ) loss of important clinical data or follow-up results. Data collection and variable definitions The data collected included information on age, sex, height, weight, BMI, pre-stroke mRS score, medical history (hypertension, diabetes mellitus, coronary artery disease, previous ischemic stroke, atrial fibrillation, current smoking, and alcohol consumption), systolic and diastolic blood pressures before the procedure, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline Alberta Stroke Program Early CT Score (ASPECTS), intravenous thrombolytic therapy, discharge NIHSS score, site of occlusion, collateral status score, anesthesia type, time from stroke onset to reperfusion, device-pass number, reperfusion status, stroke subtype, hemorrhagic transformation and type, blood glucose on admission, neutrophil and lymphocyte rates(NLR). Collateral status was assessed during the pre-thrombectomy angiogram using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral flow grading system (ASITN/SIR), which is a 5-point scale: 0 = no visible collateral circulation at the ischemic site, 1 = slow collateral circulation around the ischemic site with a persistent partial defect, 2 = rapid collateral circulation around the ischemic site with a persistent partial defect and confined to only a portion of the ischemic area, 3 = collateral circulation in the late venous phase demonstrating slow but complete angiographic blood flow in the ischemic bed, and 4 = demonstration of complete and rapid blood flow throughout the entire ischemic area vascular bed by retrograde perfusion( 10 ). Reperfusion status was assessed using the mTICI score, with grades 2b or c indicating successful reperfusion( 11 ). Symptomatic intracranial hemorrhage (sICH) was defined as the presence of new intracranial hemorrhage with an NIHSS score of ≥ 4 or ≥ 2 in cases of neurological deterioration. Hemorrhagic transformation is typically classified according to the European Cooperative Acute Stroke Study III (ECASS III) criteria. HI1 refers to scattered small petechiae without mass effect, HI2 to confluent petechiae also without mass effect, PH1 to a hematoma within infarcted tissue occupying less than 30%, and PH2 to a hematoma occupying 30% or more of the infarcted tissue with evident mass effect( 12 ). Laboratory variables were collected from the electronic medical record system. Imaging data were blinded and analyzed by two experienced neurointerventionalists. Outcome Futile recanalization was defined as patients with a mRS score of 3 to 6 at 90 days after onset, as assessed by stroke neurologists during clinical follow-up or by conducting a standardized telephone interview. Statistical analysis Continuous variables are expressed as mean ± SD or median (interquartile range). For normally distributed variables, mean ± standard deviation(SD) was used, and for non-normally distributed variables, median (interquartile range༈IQR) ༉was used. Categorical variables are expressed as frequencies (percentages). Pearson's chi-square test was used for categorical variables, while Student's t test or Mann-Whitney U test was used for continuous variables. Predictive variables for futile recanalization were identified through multivariable logistic regression analysis, with adjustment for potential confounders. These confounders were found to be statistically significant (P < 0.1) in univariate logistic regression analysis. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) from multivariable analyses were reported. All tests were two-sided with a significance level of 0.05. Result Baseline characteristics Clinical data were collected on a total of 157 patients who underwent endovascular treatment after anterior circulation infarction. 8 patients were lost to follow-up, and 29 patients were not revascularized. Variables that were selected from the univariate analysis and had a p-value less than 0.1 were included in the multivariate analysis. Our study identified previous stroke, time from onset to completion of retrieval or recanalization, and baseline NIHSS score as significant risk factors for non-recanalization. Following the inclusion criteria, patients who did not undergo revascularization after endovascular treatment were excluded, resulting in 120 patients included for anterior circulation revascularization. The median age was 65 years (55–72), with 38% being female, and a median NIHSS score of 12( 7 – 17 ). Baseline characteristics of all patients and patients with/without FR are summarized in Table 1 . Patients with FR had a higher BMI (23.9 kg/m² vs 23.0 kg/m², P = 0.034) and a higher prevalence of atrial fibrillation (33.3% vs 11.5%, P = 0.034). Additionally, baseline NIHSS score, leukocyte count, absolute neutrophil count, and D-dimer levels were all higher in patients with FR. Cardiogenic stroke, hemorrhagic transformation, discharge NIHSS scores, discharge mRS scores, and neurologic function were also associated with FR. A multifactorial analysis adjusted for confounders revealed that the NIHSS score at discharge, the neutrophil- to-lymphocyte ratio and hemorrhagic transformation were significantly associated with FR. Neutrophil-to-lymphocyte ratio was not found to be a risk factor for FR. The discharge NIHSS score, as a continuous variable, was associated with futile recanalization (per 1 score: aOR: 7.30,95%CI: 2.176–24.491, P = 0.001), indicating an increased risk, hemorrhagic transformation was also associated with higher futile recanalization risk(aOR:8.556,95%CI: 11.038–70.549, P = 0.046). Discussion Our study revealed that NIHSS score at discharge and hemorrhagic transformation were significant risk factors for functional recovery. Consistent with previous research( 13 ), we observed a correlation between higher baseline NIHSS scores and worse prognosis. However, our findings did not definitively establish NIHSS score as a risk factor for endovascular therapy. Some studies have suggested that baseline NIHSS is linked to greater clinical benefits from endovascular therapy( 14 ). According to the Heidelberg criteria and the European Cooperative Acute Stroke Study classification, hemorrhagic transformation can be categorized into asymptomatic intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), with sICH defined as any intracranial hemorrhage accompanied by neurologic deterioration (NIHSS ≥ 4 points) observed on CT within 24 hours after revascularization. Previous research has shown that symptomatic intracranial hemorrhage is linked to higher mortality and poorer clinical outcomes( 15 ). Imaging typically reveals HI2 and PH2 types in most symptomatic cerebral hemorrhages, with some studies indicating that hemorrhagic infarct type 2 and parenchymal hematoma type 2 are associated with unfavorable functional outcomes in cases of large vessel occlusion( 16 ). However, there is limited research on whether imaging findings of intracranial hemorrhage transformation without neurologic deterioration are connected to FR. The one-way analysis of variance revealed that HI1 and PH1 types were also correlated with FR, although not statistically significant after adjusting for confounders. Hemorrhagic transformation following reperfusion therapy is primarily linked to blood-brain barrier disruption and peripheral blood cell leakage post-reperfusion injury( 17 ). This disruption is closely associated with inflammatory mechanisms, oxygen radicals, and matrix metalloproteinases( 18 ). During thrombolysis, rTPA can heighten the risk of hemorrhagic transformation by activating various pathways in immune cells( 19 ). Contrary to other studies( 20 ), our research did not observe a correlation between device-pass time and futile recanalization, possibly due to our inclusion of patients with arterial thrombolysis or stenting. Neutrophils have been found to be abundant in cerebral thrombi and play a role in thrombosis( 21 ), likely due to inflammatory mediators recruiting them to ischemic tissues. Alteplase further encourages neutrophil recruitment to ischemic infarcted tissues, leading to blood-brain barrier disruption through the release of neutrophil extracellular traps (NETs) and exacerbating alteplase-induced hemorrhagic transformation( 22 ). However, our analysis did not reveal any significant association between neutrophils and futile recanalization after controlling for confounders. This lack of association may be attributed to the limitations of our small sample size, indicating the need for further research in the future. This study has several limitations. Firstly, the sample size of cardioembolic stroke cases included is small, which may introduce bias to some extent. Secondly, in the single-factor analysis, certain meaningful variables were excluded due to extreme abnormalities, which had an effect on the confounders included in the multivariate analysis. Thirdly, the presence of patients with multiple arterial occlusions in the study could have affected the analysis of the occlusion site and possibly contributed to the lack of observed effects of infarct location on FR. Conclusion In our study, previous stroke, time from onset to completion of thrombectomy or recanalization, and admission NIHSS score are significant risk factors for non-recanalization of the vessel. The relationship between the NIHSS score at discharge and FR is highlighted, suggesting the need for additional research in this area. It is important to note that while the NIHSS score may be associated with FR, it is not necessarily a risk factor for endovascular treatment. Moreover, hemorrhagic transformation is also linked to FR, possibly involving oxidative response and inflammatory mechanisms. Future studies will delve into the molecular mechanisms underlying hemorrhagic transformation. Abbreviations FR Futile recanalization LVO large vessel occlusion EVT Endovascular Therapy M1, M2 The first and second segment of middle cerebral artery mRS Modified Rankin Scale mTICI Modified Thrombolysis in Cerebral Infarction NIHSS National Institutes of Health Stroke Scale ASPECTS Alberta Stroke Program Early CT Score ICH asymptomatic intracranial hemorrhage SICH Symptomatic intracranial hemorrhage HT hemorrhagic transformation NLR neutrophil and lymphocyte rates IQR Interquartile range aOR Adjusted odds ratios CI Confidence interval Declarations Acknowledgements We thank all study participants and the clinical staff for their support and contribution to this project. Author contributions ZSF, LXT designed the study. ZSF, WYH collected the data. ZNN and WYH did data analysis. ZSF, LXT, LYC and HXY drafted the manuscript and revised it critically. All authors have critically interpreted the results and have read and approved the final manuscript. All authors read and approved the final manuscript. Funding No funding was received for this study. Data availability The data are available from the corresponding author (LXT, Email: 1900543306@ qq.com) upon reasonable request . Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was not required due to subject anonymity and minimal risk to participants. Consent for publication Not applicable. Conflict of interest The Authors declare that there is no conflict of interest. Author details 1 Department of Neurology, Guangdong Second Provincial General Hospital, Southern Medical University, Guangzhou, China. 2 Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China. 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Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30. Weber R, Nordmeyer H, Hadisurya J, Heddier M, Stauder M, Stracke P, et al. Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis. J NeuroInterventional Surg. 2017;9(3):229–33. Yang C, Hawkins KE, Doré S, Candelario-Jalil E. Neuroinflammatory mechanisms of blood-brain barrier damage in ischemic stroke. Am J Physiology-Cell Physiol. 2019;316(2):C135–53. Lee JS, Bang OY. Collateral Status and Outcomes after Thrombectomy. Transl Stroke Res. 2023;14(1):22–37. Liebeskind DS, Jahan R, Nogueira RG, Zaidat OO, Saver JL. Impact of Collaterals on Successful Revascularization in Solitaire FR With the Intention for Thrombectomy. Stroke. 2014;45(7):2036–40. Wang L, Xiong Y. Advances in Futile Reperfusion following Endovascular Treatment in Acute Ischemic Stroke due to Large Vessel Occlusion. Eur Neurol. 2023;86(2):95–106. Von Kummer R, Broderick JP, Campbell BCV, Demchuk A, Goyal M, Hill MD, et al. The Heidelberg Bleeding Classification: Classification of Bleeding Events After Ischemic Stroke and Reperfusion Therapy. Stroke. 2015;46(10):2981–6. Weyland CS, Vey JA, Mokli Y, Feisst M, Kieser M, Herweh C, et al. Full Reperfusion Without Functional Independence After Mechanical Thrombectomy in the Anterior Circulation: Performance of Prediction Models Before Versus After Treatment Initiation. Clin Neuroradiol. 2022;32(4):987–95. Lee SH, Kim BJ, Han MK, Park TH, Lee KB, Lee BC, et al. Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity. BMC Neurol. 2019;19(1):11. Ginsberg MD, Hill MD. Symptomatic Intracranial Hemorrhage in the ALIAS Multicenter Trial: Relationship to Endovascular Thrombolytic Therapy. Int J Stroke. 2015;10(4):494–500. Van Kranendonk KR, Treurniet KM, Boers AMM, Berkhemer OA, Van Den Berg LA, Chalos V, et al. Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion. J NeuroIntervent Surg. 2019;11(5):464–8. Hong JM, Kim DS, Kim M. Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management. Front Neurol. 2021;12:703258. Bernardo-Castro S, Sousa JA, Brás A, Cecília C, Rodrigues B, Almendra L, et al. Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery. Front Neurol. 2020;11:594672. Shi K, Zou M, Jia DM, Shi S, Yang X, Liu Q, et al. tPA Mobilizes Immune Cells That Exacerbate Hemorrhagic Transformation in Stroke. Circ Res. 2021;128(1):62–75. Seker F, Pfaff J, Wolf M, Ringleb PA, Nagel S, Schönenberger S, et al. Correlation of Thrombectomy Maneuver Count with Recanalization Success and Clinical Outcome in Patients with Ischemic Stroke. AJNR Am J Neuroradiol. 2017;38(7):1368–71. Laridan E, Denorme F, Desender L, François O, Andersson T, Deckmyn H, et al. Neutrophil extracellular traps in ischemic stroke thrombi. Ann Neurol. 2017;82(2):223–32. Wang R, Zhu Y, Liu Z, Chang L, Bai X, Kang L, et al. Neutrophil extracellular traps promote tPA-induced brain hemorrhage via cGAS in mice with stroke. Blood. 2021;138(1):91–103. Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4461148","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308657035,"identity":"a3c17d3b-2834-4198-95d6-1b21dc411b93","order_by":0,"name":"Shao-Fen Zhan","email":"","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shao-Fen","middleName":"","lastName":"Zhan","suffix":""},{"id":308657036,"identity":"30ef614f-051a-413e-baeb-a95265db39d2","order_by":1,"name":"Yi-Han Weng","email":"","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yi-Han","middleName":"","lastName":"Weng","suffix":""},{"id":308657039,"identity":"fa1b386e-f5b5-4f29-b4c6-a494aabde90b","order_by":2,"name":"Niu-Niu Zhang","email":"","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Niu-Niu","middleName":"","lastName":"Zhang","suffix":""},{"id":308657042,"identity":"8d44f51d-44aa-461d-a489-9f72bb104ca7","order_by":3,"name":"Yi-Cheng Liang","email":"","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yi-Cheng","middleName":"","lastName":"Liang","suffix":""},{"id":308657045,"identity":"8024d0f4-349d-4a73-9103-d540e8773c70","order_by":4,"name":"Xin-Tong Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBACNvbGhsM/eGrs2NibDxCnhY/n8MHHDDLHkvl5jiUQp0VOIi3ZmMGGmXHmDB8DIh0mkWMmXZDDxmxwg+fjjTcMdnK6DYS08Lwxk55xRobP4HbvZss5DMnGZgcIaWHPMZPg7QHacufsNmkehgOJ2whqYQBp+cfMuOFGzjMitXAAvc/DA/J+DhuRWoCB/HAGDziQjS3nGBDhF/n2xoYDHyBR+fDGmwo7OYJaUIAED5FRg6yFVB2jYBSMglEwIgAAd+RAQgJFmegAAAAASUVORK5CYII=","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xin-Tong","middleName":"","lastName":"Liu","suffix":""},{"id":308657048,"identity":"ab5cca9c-53b3-45d5-b75c-1dd346e6ab3c","order_by":5,"name":"Xu-Yin He","email":"","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xu-Yin","middleName":"","lastName":"He","suffix":""}],"badges":[],"createdAt":"2024-05-22 13:13:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4461148/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4461148/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73066750,"identity":"949b1511-b69d-4749-b8ce-a580c54bf482","added_by":"auto","created_at":"2025-01-06 11:39:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":287410,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4461148/v1/f8959fcd-92f3-40de-acb9-2c4bc76da2dc.pdf"},{"id":58054329,"identity":"6e963bae-cd01-4b74-a4aa-f9ba7d9c1b3e","added_by":"auto","created_at":"2024-06-10 13:45:27","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19062,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4461148/v1/048066918b5867121304bf60.docx"},{"id":58054330,"identity":"c96ca7c6-0894-4ab8-8391-3a4069db287b","added_by":"auto","created_at":"2024-06-10 13:45:27","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16565,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4461148/v1/e3d6ae8a0c9da92aa52812b7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prognostic factors for futile recanalization in acute anterior ischemic stroke patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndovascular therapy has become the standard treatment for patients with large vessel occlusion (LVO) stroke due to advancements in thrombolysis techniques and equipment(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), as well as the positive outcomes seen in clinical studies of EVT (endovascular therapy)(\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Futile recanalization was described as a poor clinical outcome despite successful revascularization (mTICI of 2b or c) following endovascular therapy. Nearly half of patients with anterior circulation occlusion (32.4\u0026ndash;56.7%) experienced futile recanalization after undergoing endovascular treatment(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Large vessel occlusion without timely recanalization poses a significant risk, while recanalization can also lead to reperfusion damage, including factors such as microcirculatory disorders, inflammation(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), and collateral circulation(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Identifying factors associated with predicting futile recanalization can help in selecting patients who may benefit more from Endovascular Therapy (EVT). Additionally, neurointerventionalists can tailor treatment programs based on individual patient factors. Therefore, conducting relevant clinical studies is valuable and significant for patients. This study aims to investigate factors linked to futile recanalization following endovascular treatment for acute ischemic stroke in the anterior circulation, with the goal of identifying patients who are more likely to benefit from EVT.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy subjects\u003c/p\u003e \u003cp\u003eThis postoperative study analyzed patients with acute anterior circulation large vessel occlusion who underwent endovascular therapy or a combination of endovascular therapy and intravenous thrombolysis at the Second People's Hospital of Guangdong Province from June 2019 to October 2023. The study was approved by the Ethics Committee of the Second People's Hospital of Guangdong Province. The selection criteria were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)age over 18 years old; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)confirmed through CT or MR imaging to have acute circulation occlusion without cerebral hemorrhage; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)achieving successful recanalization (final mTICI 2b or 3) after treatment; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)absence of traumatic brain injury, cerebral hemorrhage, or other cerebral diseases within 6 months, (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) functional independence (a mRS score of 0\u0026ndash;1) before stroke; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)imaging indicating acute anterior circulation occlusion (internal carotid artery (ICA) and/or middle cerebral artery (MCA) M1 or proximal M2); (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)ability to cooperate with research requirements and provide informed consent; (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)blood tests within 24 hours post-treatment; (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)a 90-day follow-up mRS score assessment. The exclusion criteria were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) occlusion of posterior; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Patients with myasthenia gravis, hypokalemic periodic paralysis, and other symptoms may be caused by non-cerebral infarction; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)failed recanalization; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) loss of important clinical data or follow-up results.\u003c/p\u003e \u003cp\u003eData collection and variable definitions\u003c/p\u003e \u003cp\u003eThe data collected included information on age, sex, height, weight, BMI, pre-stroke mRS score, medical history (hypertension, diabetes mellitus, coronary artery disease, previous ischemic stroke, atrial fibrillation, current smoking, and alcohol consumption), systolic and diastolic blood pressures before the procedure, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline Alberta Stroke Program Early CT Score (ASPECTS), intravenous thrombolytic therapy, discharge NIHSS score, site of occlusion, collateral status score, anesthesia type, time from stroke onset to reperfusion, device-pass number, reperfusion status, stroke subtype, hemorrhagic transformation and type, blood glucose on admission, neutrophil and lymphocyte rates(NLR). Collateral status was assessed during the pre-thrombectomy angiogram using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral flow grading system (ASITN/SIR), which is a 5-point scale: 0\u0026thinsp;=\u0026thinsp;no visible collateral circulation at the ischemic site, 1\u0026thinsp;=\u0026thinsp;slow collateral circulation around the ischemic site with a persistent partial defect, 2\u0026thinsp;=\u0026thinsp;rapid collateral circulation around the ischemic site with a persistent partial defect and confined to only a portion of the ischemic area, 3\u0026thinsp;=\u0026thinsp;collateral circulation in the late venous phase demonstrating slow but complete angiographic blood flow in the ischemic bed, and 4\u0026thinsp;=\u0026thinsp;demonstration of complete and rapid blood flow throughout the entire ischemic area vascular bed by retrograde perfusion(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Reperfusion status was assessed using the mTICI score, with grades 2b or c indicating successful reperfusion(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Symptomatic intracranial hemorrhage (sICH) was defined as the presence of new intracranial hemorrhage with an NIHSS score of \u0026ge;\u0026thinsp;4 or \u0026ge;\u0026thinsp;2 in cases of neurological deterioration. Hemorrhagic transformation is typically classified according to the European Cooperative Acute Stroke Study III (ECASS III) criteria. HI1 refers to scattered small petechiae without mass effect, HI2 to confluent petechiae also without mass effect, PH1 to a hematoma within infarcted tissue occupying less than 30%, and PH2 to a hematoma occupying 30% or more of the infarcted tissue with evident mass effect(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Laboratory variables were collected from the electronic medical record system. Imaging data were blinded and analyzed by two experienced neurointerventionalists.\u003c/p\u003e\n\u003ch3\u003eOutcome\u003c/h3\u003e\n\u003cp\u003eFutile recanalization was defined as patients with a mRS score of 3 to 6 at 90 days after onset, as assessed by stroke neurologists during clinical follow-up or by conducting a standardized telephone interview.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (interquartile range). For normally distributed variables, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation(SD) was used, and for non-normally distributed variables, median (interquartile range༈IQR) ༉was used. Categorical variables are expressed as frequencies (percentages). Pearson's chi-square test was used for categorical variables, while Student's t test or Mann-Whitney U test was used for continuous variables. Predictive variables for futile recanalization were identified through multivariable logistic regression analysis, with adjustment for potential confounders. These confounders were found to be statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.1) in univariate logistic regression analysis. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) from multivariable analyses were reported. All tests were two-sided with a significance level of 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eBaseline characteristics\u003c/p\u003e \u003cp\u003eClinical data were collected on a total of 157 patients who underwent endovascular treatment after anterior circulation infarction. 8 patients were lost to follow-up, and 29 patients were not revascularized. Variables that were selected from the univariate analysis and had a p-value less than 0.1 were included in the multivariate analysis. Our study identified previous stroke, time from onset to completion of retrieval or recanalization, and baseline NIHSS score as significant risk factors for non-recanalization. Following the inclusion criteria, patients who did not undergo revascularization after endovascular treatment were excluded, resulting in 120 patients included for anterior circulation revascularization. The median age was 65 years (55\u0026ndash;72), with 38% being female, and a median NIHSS score of 12(\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Baseline characteristics of all patients and patients with/without FR are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Patients with FR had a higher BMI (23.9 kg/m\u0026sup2; vs 23.0 kg/m\u0026sup2;, P\u0026thinsp;=\u0026thinsp;0.034) and a higher prevalence of atrial fibrillation (33.3% vs 11.5%, P\u0026thinsp;=\u0026thinsp;0.034). Additionally, baseline NIHSS score, leukocyte count, absolute neutrophil count, and D-dimer levels were all higher in patients with FR. Cardiogenic stroke, hemorrhagic transformation, discharge NIHSS scores, discharge mRS scores, and neurologic function were also associated with FR.\u003c/p\u003e \u003cp\u003eA multifactorial analysis adjusted for confounders revealed that the NIHSS score at discharge, the neutrophil- to-lymphocyte ratio and hemorrhagic transformation were significantly associated with FR. Neutrophil-to-lymphocyte ratio was not found to be a risk factor for FR. The discharge NIHSS score, as a continuous variable, was associated with futile recanalization (per 1 score: aOR: 7.30,95%CI: 2.176\u0026ndash;24.491, P\u0026thinsp;=\u0026thinsp;0.001), indicating an increased risk, hemorrhagic transformation was also associated with higher futile recanalization risk(aOR:8.556,95%CI: 11.038\u0026ndash;70.549, P\u0026thinsp;=\u0026thinsp;0.046).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study revealed that NIHSS score at discharge and hemorrhagic transformation were significant risk factors for functional recovery. Consistent with previous research(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), we observed a correlation between higher baseline NIHSS scores and worse prognosis. However, our findings did not definitively establish NIHSS score as a risk factor for endovascular therapy. Some studies have suggested that baseline NIHSS is linked to greater clinical benefits from endovascular therapy(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). According to the Heidelberg criteria and the European Cooperative Acute Stroke Study classification, hemorrhagic transformation can be categorized into asymptomatic intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), with sICH defined as any intracranial hemorrhage accompanied by neurologic deterioration (NIHSS\u0026thinsp;\u0026ge;\u0026thinsp;4 points) observed on CT within 24 hours after revascularization. Previous research has shown that symptomatic intracranial hemorrhage is linked to higher mortality and poorer clinical outcomes(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Imaging typically reveals HI2 and PH2 types in most symptomatic cerebral hemorrhages, with some studies indicating that hemorrhagic infarct type 2 and parenchymal hematoma type 2 are associated with unfavorable functional outcomes in cases of large vessel occlusion(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, there is limited research on whether imaging findings of intracranial hemorrhage transformation without neurologic deterioration are connected to FR. The one-way analysis of variance revealed that HI1 and PH1 types were also correlated with FR, although not statistically significant after adjusting for confounders. Hemorrhagic transformation following reperfusion therapy is primarily linked to blood-brain barrier disruption and peripheral blood cell leakage post-reperfusion injury(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This disruption is closely associated with inflammatory mechanisms, oxygen radicals, and matrix metalloproteinases(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). During thrombolysis, rTPA can heighten the risk of hemorrhagic transformation by activating various pathways in immune cells(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Contrary to other studies(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), our research did not observe a correlation between device-pass time and futile recanalization, possibly due to our inclusion of patients with arterial thrombolysis or stenting. Neutrophils have been found to be abundant in cerebral thrombi and play a role in thrombosis(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), likely due to inflammatory mediators recruiting them to ischemic tissues. Alteplase further encourages neutrophil recruitment to ischemic infarcted tissues, leading to blood-brain barrier disruption through the release of neutrophil extracellular traps (NETs) and exacerbating alteplase-induced hemorrhagic transformation(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, our analysis did not reveal any significant association between neutrophils and futile recanalization after controlling for confounders. This lack of association may be attributed to the limitations of our small sample size, indicating the need for further research in the future. This study has several limitations. Firstly, the sample size of cardioembolic stroke cases included is small, which may introduce bias to some extent. Secondly, in the single-factor analysis, certain meaningful variables were excluded due to extreme abnormalities, which had an effect on the confounders included in the multivariate analysis. Thirdly, the presence of patients with multiple arterial occlusions in the study could have affected the analysis of the occlusion site and possibly contributed to the lack of observed effects of infarct location on FR.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eIn our study, previous stroke, time from onset to completion of thrombectomy or recanalization, and admission NIHSS score are significant risk factors for non-recanalization of the vessel. The relationship between the NIHSS score at discharge and FR is highlighted, suggesting the need for additional research in this area. It is important to note that while the NIHSS score may be associated with FR, it is not necessarily a risk factor for endovascular treatment. Moreover, hemorrhagic transformation is also linked to FR, possibly involving oxidative response and inflammatory mechanisms. Future studies will delve into the molecular mechanisms underlying hemorrhagic transformation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Futile recanalization\u003c/p\u003e\n\u003cp\u003eLVO \u0026nbsp; \u0026nbsp; \u0026nbsp; large vessel occlusion\u003c/p\u003e\n\u003cp\u003eEVT \u0026nbsp; \u0026nbsp; \u0026nbsp; Endovascular Therapy\u003c/p\u003e\n\u003cp\u003eM1, M2 \u0026nbsp; \u0026nbsp;The first and second segment of middle cerebral artery\u003c/p\u003e\n\u003cp\u003emRS \u0026nbsp; \u0026nbsp; \u0026nbsp; Modified Rankin Scale\u003c/p\u003e\n\u003cp\u003emTICI \u0026nbsp; \u0026nbsp; \u0026nbsp;Modified Thrombolysis in Cerebral Infarction\u003c/p\u003e\n\u003cp\u003eNIHSS \u0026nbsp; \u0026nbsp; \u0026nbsp;National Institutes of Health Stroke Scale\u003c/p\u003e\n\u003cp\u003eASPECTS \u0026nbsp; Alberta Stroke Program Early CT Score\u003c/p\u003e\n\u003cp\u003eICH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;asymptomatic intracranial hemorrhage\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSICH \u0026nbsp; \u0026nbsp; \u0026nbsp; Symptomatic intracranial hemorrhage\u003c/p\u003e\n\u003cp\u003eHT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; hemorrhagic transformation\u003c/p\u003e\n\u003cp\u003eNLR \u0026nbsp; \u0026nbsp; \u0026nbsp; neutrophil and lymphocyte rates\u003c/p\u003e\n\u003cp\u003eIQR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Interquartile range\u003c/p\u003e\n\u003cp\u003eaOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Adjusted odds ratios\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Confidence interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all study participants and the clinical staff for their support and contribution to this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZSF, LXT designed the study. ZSF, WYH collected the data. ZNN and WYH did data analysis. ZSF, LXT, LYC and HXY drafted the manuscript and revised it critically. All authors have critically interpreted the results and have read and approved the final manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available from the corresponding author (LXT, Email: 1900543306@ qq.com) upon reasonable request\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was not required due to subject anonymity and minimal risk to participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors declare that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1\u0026nbsp;Department of Neurology,\u0026nbsp;Guangdong Second Provincial General Hospital, Southern Medical University, Guangzhou, China.\u003c/p\u003e\n\u003cp\u003e2 Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSaini V, Guada L, Yavagal DR. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology. 2021;97(20S):S6\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJovin TG, Chamorro A, Cobo E, De Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke. N Engl J Med. 2015;372(24):2296\u0026ndash;306.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018;378(1):11\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018;378(8):708\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection. N Engl J Med. 2015;372(11):1009\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeber R, Nordmeyer H, Hadisurya J, Heddier M, Stauder M, Stracke P, et al. Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis. J NeuroInterventional Surg. 2017;9(3):229\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang C, Hawkins KE, Dor\u0026eacute; S, Candelario-Jalil E. Neuroinflammatory mechanisms of blood-brain barrier damage in ischemic stroke. Am J Physiology-Cell Physiol. 2019;316(2):C135\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JS, Bang OY. Collateral Status and Outcomes after Thrombectomy. Transl Stroke Res. 2023;14(1):22\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiebeskind DS, Jahan R, Nogueira RG, Zaidat OO, Saver JL. Impact of Collaterals on Successful Revascularization in Solitaire FR With the Intention for Thrombectomy. Stroke. 2014;45(7):2036\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang L, Xiong Y. Advances in Futile Reperfusion following Endovascular Treatment in Acute Ischemic Stroke due to Large Vessel Occlusion. Eur Neurol. 2023;86(2):95\u0026ndash;106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVon Kummer R, Broderick JP, Campbell BCV, Demchuk A, Goyal M, Hill MD, et al. The Heidelberg Bleeding Classification: Classification of Bleeding Events After Ischemic Stroke and Reperfusion Therapy. Stroke. 2015;46(10):2981\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeyland CS, Vey JA, Mokli Y, Feisst M, Kieser M, Herweh C, et al. Full Reperfusion Without Functional Independence After Mechanical Thrombectomy in the Anterior Circulation: Performance of Prediction Models Before Versus After Treatment Initiation. Clin Neuroradiol. 2022;32(4):987\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee SH, Kim BJ, Han MK, Park TH, Lee KB, Lee BC, et al. Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity. BMC Neurol. 2019;19(1):11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGinsberg MD, Hill MD. Symptomatic Intracranial Hemorrhage in the ALIAS Multicenter Trial: Relationship to Endovascular Thrombolytic Therapy. Int J Stroke. 2015;10(4):494\u0026ndash;500.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Kranendonk KR, Treurniet KM, Boers AMM, Berkhemer OA, Van Den Berg LA, Chalos V, et al. Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion. J NeuroIntervent Surg. 2019;11(5):464\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong JM, Kim DS, Kim M. Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management. Front Neurol. 2021;12:703258.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernardo-Castro S, Sousa JA, Br\u0026aacute;s A, Cec\u0026iacute;lia C, Rodrigues B, Almendra L, et al. Pathophysiology of Blood\u0026ndash;Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery. Front Neurol. 2020;11:594672.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShi K, Zou M, Jia DM, Shi S, Yang X, Liu Q, et al. tPA Mobilizes Immune Cells That Exacerbate Hemorrhagic Transformation in Stroke. Circ Res. 2021;128(1):62\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeker F, Pfaff J, Wolf M, Ringleb PA, Nagel S, Sch\u0026ouml;nenberger S, et al. Correlation of Thrombectomy Maneuver Count with Recanalization Success and Clinical Outcome in Patients with Ischemic Stroke. AJNR Am J Neuroradiol. 2017;38(7):1368\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaridan E, Denorme F, Desender L, Fran\u0026ccedil;ois O, Andersson T, Deckmyn H, et al. Neutrophil extracellular traps in ischemic stroke thrombi. Ann Neurol. 2017;82(2):223\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang R, Zhu Y, Liu Z, Chang L, Bai X, Kang L, et al. Neutrophil extracellular traps promote tPA-induced brain hemorrhage via cGAS in mice with stroke. Blood. 2021;138(1):91\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Futile recanalization, FR, Acute anterior ischemic stroke, Endovascular therapy","lastPublishedDoi":"10.21203/rs.3.rs-4461148/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4461148/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e More than half of the patients who underwent endovascular treatment for reperfusion had a poor prognosis. Our study aimed to investigate the factors associated with futile reperfusion following endovascular treatment in patients with acute ischemic stroke.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study conducted a postoperative analysis at Guangdong Province Second People's Hospital, focusing on patients with anterior circulation large-vessel occlusion who underwent endovascular treatment or a combination of intravenous thrombolysis from June 2019 to October 2023. Futile recanalization was determined based on a modified Rankin score of 3-6 at 90 days post-treatment. The researchers utilized multifactorial logistic regression to identify factors linked to futile recanalization following reperfusion in patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 120 patients were enrolled, amongst which 52 patients (43.3%) had FR. After adjusting for confounders, the discharge NIHSS score, as a continuous variable, was associated with futile recanalization (per 1 score: aOR: 7.30,95%CI: 2.176-24.491, P=0.001), indicating an increased risk, hemorrhagic transformation was also associated with higher futile recanalization risk(aOR:8.556,95%CI: 11.038-70.549, P=0.046).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn patients with large anterior circulation stroke, our findings suggest that the discharge INHSS score and hemorrhagic transformation are risk factors for FR.\u003c/p\u003e","manuscriptTitle":"Prognostic factors for futile recanalization in acute anterior ischemic stroke patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-10 13:45:23","doi":"10.21203/rs.3.rs-4461148/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"71fb752d-e3b7-4157-a3d3-64eac53ed205","owner":[],"postedDate":"June 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T11:23:40+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-10 13:45:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4461148","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4461148","identity":"rs-4461148","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}