Incidence and predictors of futile recanalisation after endovascular therapy in acute vertebrobasilar artery occlusion patients: insight from the ANGEL-ACT registry

Abstract

ObjectivesTo identify the occurrence rate and predictors of futile recanalisation after endovascular therapy (EVT) for acute vertebrobasilar artery occlusion (VBAO).MethodsParticipants of the Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischaemic Stroke (ANGEL-ACT) registry were selected for the analysis. Futile recanalisation was defined as patients did not achieve a 90-day good outcome (modified Rankin Scale ≤3) despite successful recanalisation (modified Treatment in Cerebral Ischaemia Scale ≥2b) after the procedure. Multivariable logistic regression analysis was conducted to find independent predictors of futile recanalisation in VBAO patients undergoing EVT.ResultsThree hundred and fifteen patients with VBAO who achieved successful recanalisation after EVT were included in current analysis, of whom, 155 (49.2%) suffered futile recanalisation, and 160 achieved effective recanalisation. After the multivariable analysis, we found admission National Institutes of Health Stroke Scale (NIHSS) ≥19 (OR 4.81, 95% CI 2.76 to 8.39, p<0.001), platelet-lymphocyte ratio (PLR) ≥162.2 (OR 1.93, 95% CI 1.14 to 3.27, p=0.001), onset-to-puncture time (OTP) ≥334 min (OR 2.15, 95% CI 1.25 to 3.68, p=0.005) and use of general anesthesia (GA) (OR 1.87, 95% CI 1.09 to 3.22, p=0.024) were associated with futile recanalisation.ConclusionsFutile recanalisation after EVT occurred 49.2% of VBAO patients in the ANGEL-ACT registry. NIHSS≥19, PLR≥162.2, OTP≥334 min and use of GA were independent predictors of futile recanalisation.

CBF Profile in Computed Tomography Perfusion-Based AutoMIStar Software Predicts Futile Recanalization After Basilar Artery Thrombectomy

“…However, a previous study proposed a BATMAN score of 3 as the optimal threshold for predicting FR following EVT in BAO stroke. 34 Moreover, a recent BASILAR sub-study showed that although patients with lower BATMAN scores (0-3 and 4-6) had worse functional outcomes than those with higher scores (7)(8)(9), they could still benefit from EVT compared to BMM. 35 These conflicting findings underscore the need for future research to determine the feasibility of using specific BATMAN score thresholds in identifying BAO patients amenable to EVT.…”

“…2,3 However, real-world registry studies have revealed that despite achieving successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grade ≥ 2b), approximately 47.0-62.8% of BAO patients still exhibit unfavorable outcomes (modified Rankin Scale score [mRS] > 3) at 90 days after EVT. [4][5][6][7] The underlying mechanisms of this phenomenon known as futile recanalization (FR) remain incompletely clear. Therefore, the identification of risk factors or predictors for FR is crucial in assisting clinicians in selecting appropriate BAO patients for EVT and developing tailored patient management strategies.…”