Stroke severity and procedural duration were independently associated with futile recanalization in both models, imaging variables (collateral status, ASPECTS) added prognostic information in anterior circulation infarction, and age ≥80 years was not independently associated with futile recanalization; the NLR association and age-stratified findings remain exploratory.
Futile recanalization was common despite successful angiographic recanalization after endovascular therapy.
In Model 1 (all patients with successful recanalization), admission NIHSS, admission glucose, and puncture-to-recanalization time were independently associated with futile recanalization.
In Model 2 (anterior circulation infarction with assessable imaging), sufficient collateral status and higher ASPECTS were associated with lower odds of futile recanalization.
Model 2 also identified NIHSS, neutrophil-to-lymphocyte ratio, dyslipidemia, and procedural duration as independent factors, while glucose was not retained.
Model 2 showed high discrimination for futile recanalization.
Age ≥80 years was not independently associated with futile recanalization, and age interactions were largely absent.
Stroke severity and procedural duration were the factors independently associated with futile recanalization consistently across both models.
This study looked at stroke patients whose blocked brain artery was successfully reopened with a clot-removal procedure (endovascular therapy) but who still did not regain independence three months later, a situation called futile recanalization. Among 231 patients treated at one center between 2021 and 2024, the artery was reopened in 191, and about 6 in 10 of those (114 patients) still had poor functional outcomes. The analysis suggests that more severe strokes at admission (higher NIHSS scores) and longer procedures were linked to a greater chance of futile recanalization. Higher blood glucose on admission was also linked in the full group. In patients with strokes in the front part of the brain, better collateral blood flow and higher ASPECTS scores (a measure of early brain damage on CT) were linked to lower odds of a poor outcome, while higher NLR (an inflammation marker), dyslipidemia, and longer procedures were linked to higher odds. A model combining these factors separated patients with and without futile recanalization well (AUC 0.88). Being 80 or older was not by itself independently linked to futile recanalization once other factors were considered. This research suggests that age alone may not be a good reason to rule out treatment. The study was retrospective and done at a single center, and the authors describe the inflammation marker and age-group findings as exploratory, so the results need confirmation in larger studies.
Tanriverdi Z, Mingsar E, Emik I, Ture H, Balli O, Beckmann Y. (2026). Determinants of Futile Recanalization and the Influence of Age After Endovascular Therapy for Acute Ischemic Stroke: A Retrospective Single-Center Cohort Study.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62102036