Ischemic Lesion Net Water Uptake Outperforms ASPECTS and CBF Less Than 30% in Predicting Futile Recanalization after Mechanical Thrombectomy

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke due to large vessel occlusion (n=530). Intervention: Ischemic lesion net water uptake (NWU) vs. ASPECTS and rCBF30 volume. Primary outcome: Futile recanalization (90-day modified Rankin Scale score of 3-6).

Dhairya A. Lakhani; Hamza Salim; V S R K Yedavalli; Tyler McGaughey; Adam A. Dmytriw; Orabi Hajjeh; Janet Mei; Gabriel Broocks; Jens Fiehler; Helge Kniep; Mostafa Ergawy; Gregory W. Albers; Paul Stracke; Hermann Krähling; Jens Minnerup; Dheeraj Gandhi; Max Wintermark; Jeremy J. Heit; Tobias D. Faizy

doi:10.1148/radiol.252487

Key result

Admission CT net water uptake predicts futile recanalization better than rCBF30 volume or ASPECTS after stroke thrombectomy.

n=530

Why the study?

Whether ischemic lesion net water uptake (NWU) outperforms ASPECTS and CT perfusion-derived relative cerebral blood flow less than 30% in predicting futile recanalization after mechanical thrombectomy remains uncertain.

Does ischemic lesion net water uptake (NWU) outperform ASPECTS and rCBF30 in predicting futile recanalization in patients with acute ischemic stroke after successful mechanical thrombectomy?

Key Points

To determine whether ischemic lesion net water uptake predicts futile recanalization after successful mechanical thrombectomy and compare its predictive accuracy with ASPECTS and rCBF30 volume.
Retrospective study of 530 patients with large vessel occlusion acute ischemic stroke who achieved successful reperfusion (mTICI 2b-3) at two comprehensive stroke centers between January 2019 and December 2024.
Admission noncontrast CT was used to quantify net water uptake and ASPECTS, while CT perfusion was used to calculate rCBF30 volume.
Futile recanalization was defined as a 90-day modified Rankin Scale score of 3-6 and evaluated using logistic regression and receiver operating characteristic curve analyses.
Futile recanalization occurred in 58.9% (312 of 530) of patients despite achieving successful endovascular reperfusion.
Patients with futile recanalization had markedly higher median net water uptake than those with favorable outcomes (7.77% vs 2.75%).

Study Design

Type

Observational (n=530)

Multicenter

Yes

Structured PICO

Does ischemic lesion net water uptake (NWU) outperform ASPECTS and rCBF30 in predicting futile recanalization in patients with acute ischemic stroke after successful mechanical thrombectomy?

P

Population

530 patients with acute ischemic stroke due to large vessel occlusion who achieved successful reperfusion, evaluated for predictors of futile recanalization at 90 days.

E

Exposure

Ischemic lesion net water uptake (NWU) measured on admission CT

C

Comparator

Alberta Stroke Program Early CT Score (ASPECTS) and CT perfusion (CTP)-derived relative cerebral blood flow less than 30% (rCBF30) volume

O

Outcome

Futile recanalization (FR), defined as a 90-day modified Rankin Scale score of 3-6hard clinical

Main Result

Absolute Event Rate: 7.77% vs 2.75%

Implication

Ischemic lesion net water uptake on admission CT is associated with futile recanalization in patients with acute ischemic stroke and large vessel occlusion despite successful thrombectomy.

Abstract

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Discussion

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Cite This Study

Lakhani et al. (2026) conducted an observational in Acute ischemic stroke due to large vessel occlusion (n=530). Ischemic lesion net water uptake (NWU) vs. ASPECTS and rCBF30 volume was evaluated on Futile recanalization (90-day modified Rankin Scale score of 3-6). Median ischemic lesion net water uptake was higher in patients who experienced futile recanalization after mechanical thrombectomy compared to those who did not (7.77% vs 2.75%).

synapsesocial.com/papers/6a338ba9630953a74978d2e1 https://doi.org/10.1148/radiol.252487

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Ischemic Lesion Net Water Uptake Outperforms ASPECTS and CBF Less Than 30% in Predicting Futile Recanalization after Mechanical Thrombectomy

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

Ischemic Lesion Net Water Uptake Outperforms ASPECTS and CBF Less Than 30% in Predicting Futile Recanalization after Mechanical Thrombectomy

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

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