Predictors of futile recanalization in patients with large infarct: a post hoc analysis of the ANGEL-ASPECT trial

Abstract

Background: Few studies have focused on factors associated with futile recanalization in acute anterior circulation stroke patients with large infarct cores who were treated with modern endovascular therapy (EVT). The aim of this study was to explore the factors associated with futile recanalization in patients with large ischemic strokes. Methods: This is a post hoc analysis of the ANGEL-ASPECT trial. Demographic and clinical characteristics, acute stroke workflow interval times, and imaging characteristics were compared between the futile and meaningful recanalization groups. A favorable outcome was defined as a 90-day mRS score 0-3, successful reperfusion was defined as eTICI 2b, 2c and 3 on final angiogram, and futile recanalization was defined as failure to achieve a favorable outcome despite successful reperfusion. Multivariate analysis was performed to identify the predictors of futile recanalization. Results: One hundred eighty-three patients were included in the final analysis; 91 (49.7%) patients had futile recanalization, and 92 (51.3%) patients had meaningful recanalization. In multivariable logistic regression analysis, older age (age ≥68, OR=3.29, P=0.004), higher NIHSS score (NIHSS ≥16, OR=3.33, P=0.003), diabetes (OR=3.23, P=0.017), larger final volume (FIV ≥174.7, OR=6.79, P<0.001), postoperative respiratory failure (OR=14.56, P=0.01), and female sex (OR=2.78, P=0.01) were independent predictors of futile recanalization. Conclusions: Futile recanalization occurred in approximately half of acute stroke patients with a large infarct core following endovascular treatment. Old age, high baseline NIHSS score, diabetes mellitus, large FIV and respiratory failure were independent predictors of futile recanalization after endovascular therapy for large ischemic strokes. Stroke-related pneumonia control may improve prognosis.