What question did this study set out to answer?

The study aimed to identify risk factors for futile recanalization (FR) after endovascular treatment (EVT) in patients with large-core ischemic stroke.

May 8, 2026Open Access

Abstract Number: Esoc2026a989 Risk Factors for Futile Recanalization After Endovascular Treatment in Large-Core Ischemic Stroke: Insights From Real-World Clinical Practice

Q: What does this research mean for the field?

Advanced age, higher initial stroke severity, diabetes, tandem occlusion, and symptomatic intracranial hemorrhage independently increase the risk of futile recanalization after endovascular treatment in large-core ischemic stroke, whereas prior intravenous thrombolysis is protective. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Puntos clave

The study aimed to identify risk factors for futile recanalization (FR) after endovascular treatment (EVT) in patients with large-core ischemic stroke.
Multicenter retrospective analysis of patients with large-core ischemic strokes (ASPECTS ≤5) due to anterior circulation LVO within 24 hours.
Evaluated risk factors using multivariate logistic regression on demographic, imaging, and procedural data.
Defined FR as modified Rankin Scale (mRS) ≥3 at 90 days despite achieving modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b.
Among 363 patients, 332 achieved successful recanalization, with a 56% FR rate (186/332).
Independent predictors of FR included advanced age (OR 1.063), higher NIHSS scores (OR 1.056), diabetes (OR 2.28), tandem occlusion (OR 2.056), and symptomatic intracranial hemorrhage (OR 27.55).
Intravenous thrombolysis was protective against FR (OR 0.46).

Resumen

Abstract Background and aims Endovascular treatment (EVT) is the standard of care for acute ischemic stroke (AIS) with large vessel occlusion (LVO), including patients with large-core infarcts. However, futile recanalization (FR)—successful angiographic reperfusion without functional recovery—remains a major challenge. This study aimed to identify risk factors for FR in patients with large-core AIS undergoing EVT. Methods We conducted a multicenter, retrospective analysis of patients with large ischemic strokes (ASPECTS ≤5) due to anterior circulation LVO within 24 hours (July 2023–September 2024). FR was defined as modified Rankin Scale (mRS) ≥3 at 90 days despite achieving modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. Baseline demographics, imaging, and procedural variables were collected. Multivariate logistic regression analyses identified independent predictors. Results Of 363 patients, 332 achieved successful recanalization, with an FR rate of 56% (186/332). Compared with non-FR, FR patients were older (67.3 vs 58.5, p0.001), had higher NIHSS score (19 vs 16, p0.001), and more diabetes (p=0.001) and atrial fibrillation (p=0.002). Median puncture-to-reperfusion times were longer in FR patients but not independently predictive. Multivariate analysis showed age (OR 1.063; 95% CI 1.038–1.089; p0.001), NIHSS score (OR 1.056; p=0.029), diabetes (OR 2.28; p=0.01), tandem occlusion (OR 2.056; p=0.03), and symptomatic intracranial hemorrhage (OR 27.55; p0.001) were independent associated with FR, while prior IV tPA was protective (OR 0.46; p=0.015). Conclusions Advanced age, higher initial NIHSS, diabetes, tandem occlusion, and post-procedural symptomatic intracranial hemorrhage increase FR risk, whereas intravenous thrombolysis may reduce it. These findings highlight the need for individualized treatment strategies for this high-risk population. Conflict of interest Hang Tran: nothing to disclose, Trung Quoc Nguyen: nothing to disclose, Khang Nguyen: nothing to disclose, Thien Le: nothing to disclose, Dung Bach: nothing to disclose, Lanh Nguyen: nothing to disclose, Thang Huy Nguyen: nothing to disclose

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