Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis

Abstract

BackgroundDespite successful recanalization after endovascular treatment, many patients with acute ischemic stroke due to large vessel occlusion still show functional dependence, namely futile recanalization.MethodsPubMed and Embase were searched up to April 30, 2021. Studies that reported risk factors for futile recanalization following endovascular treatment of acute ischemic stroke were included. The mean difference (MD) or odds ratio (OR) and 95% confidence interval (95% CI) of each study were pooled for a meta-analysis.ResultsTwelve studies enrolling 2138 patients were included. The pooled analysis showed that age (MD 5.81, 95% CI 4.16 to 7.46), female sex (OR 1.40, 95% CI 1.16 to 1.68), National Institutes of Health Stroke Scale (NIHSS) score (MD 4.22, 95% CI 3.38 to 5.07), Alberta Stroke Program Early CT Score (ASPECTS) (MD −0.71, 95% CI −1.23 to –0.19), hypertension (OR 1.73, 95% CI 1.43 to 2.09), diabetes (OR 1.78, 95% CI 1.41 to 2.24), atrial fibrillation (OR 1.24, 95% CI 1.01 to 1.51), admission systolic blood pressure (MD 4.98, 95% CI 1.87 to 8.09), serum glucose (MD 0.59, 95% CI 0.37 to 0.81), internal carotid artery occlusion (OR 1.85, 95% CI 1.17 to 2.95), pre-treatment intravenous thrombolysis (OR 0.67, 95% CI 0.55 to 0.83), onset-to-puncture time (MD 16.92, 95% CI 6.52 to 27.31), puncture-to-recanalization time (MD 12.37, 95% CI 7.96 to 16.79), and post-treatment symptomatic intracerebral hemorrhage (OR 6.09, 95% CI 3.18 to 11.68) were significantly associated with futile recanalization.ConclusionThis study identified female sex, comorbidities, admission systolic blood pressure, serum glucose, occlusion site, non-bridging therapy, and post-procedural complication as predictors of futile recanalization, and also confirmed previously reported factors. Further large-scale prospective studies are needed.

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

“…Several generic markers including age, gender, stroke severity, time from onset to puncture, and comorbidities (hypertension, diabetes, and atrial fibrillation) have been reported associated with clinical outcomes after EVT ( 4 , 7 , 22 ). In the present study, we also identified that the unfavorable functional outcome group was older, and had higher proportion of female, higher incidence of diabetes mellitus, and higher baseline NIHSS scores.…”

Multivariable Prediction Model for Futile Recanalization Therapies in Patients With Acute Ischemic Stroke

“…The final cohort included 2261 patients: median (IQR) age 75 years (64-83), 46% female, median NIHSS 9 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). 34% received IVT alone, 41% MT alone and 25% both acute recanalization treatments (bridging approach).…”

“…[8][9][10] Several clinical and imaging biomarkers associated with FRT have been identified. 4,[11][12][13][14][15][16][17][18] However, the models developed for MT are insufficient to reliably inform patient and proxies and to guide the decision-making in individual patients. [19][20][21][22] Besides the MR PREDICT tool, 23 which can be used for patients undergoing bridging IVT, no model for IVT-only patients not fulfilling endovascular trial criteria has been developed in the context of contemporary MT.…”

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“…However, the question remains as whether these variables are the cause or the result of the futile recanalization, which need further studies to determine the causal-effect relationship. Several generic markers including age, gender, stroke severity, time from onset to puncture, and comorbidities (hypertension, diabetes, and atrial fibrillation) have been reported associated with clinical outcomes after EVT (4,7,22). In the present study, we also identified that the unfavorable functional outcome group was older, and had higher proportion of female, higher incidence of diabetes mellitus, and higher baseline NIHSS scores.…”

“…Moreover, ~50% of successful recanalized AIS patients have a poor 3-month functional dependency [modified Rankin Scale (mRS) of [3][4][5][6], which is the condition that is termed as futile recanalization (5,6). Accurate prediction of these early and longterm clinical outcomes may help to identify AIS patients suitable for EVT and optimize adjunct therapeutic strategies (4,7).…”