Background

Futile recanalization, defined as the early recanalization of an occluded artery failing to improve neurological outcome, remains a persistent concern in the endovascular treatment of acute ischemic stroke. We investigated the occurrence and predictors of futile recanalization after endovascular treatment in a nationwide multicenter stroke registry study.

Methods

The subjects consisted of eligible patients from the Acute Ischemic Stroke Cooperation Group of Endovascular Treatment registry study (2015–2017). Subjects with acute anterior large vessel occlusion who achieved successful angiographic recanalization (defined as modified Thrombolysis in Cerebral Infarction grades 2b or 3) by endovascular treatment were dichotomized into the futile-recanalization group (with a modified Rankin Scale score of 3–6) and the favorable-recanalization group (with a modified Rankin Scale score of 0–2) according to 90-day functional independence. Logistic regression analysis was performed to investigate predictors of futile recanalization.

Results

Futile recanalization was observed in 200 (49.6%) out of 403 patients. On multivariate analysis, older age (>74 vs. ≤74; odds ratio (OR), 2.41; 95% confidence interval (CI), 1.31–4.44; P=0.005), high baseline National Institutes of Health Stroke Scale score (>21 vs. ≤13; OR, 2.52; 95% CI, 1.21–5.28; P=0.014), delayed puncture to recanalization time (>80 vs. ≤80 min; OR, 2.75; 95% CI, 1.67–4.51; P=0.000), and the use of general anesthesia (OR, 1.90; 95% CI, 1.15–3.14; P=0.012) were positively associated with futile recanalization after mechanical thrombectomy.

Conclusions

The incidence of futile recanalization is common following endovascular treatment among Asian patients with anterior circulation occlusion. Advanced age, higher baseline National Institutes of Health Stroke Scale score, delayed puncture to reperfusion, and the use of general anesthesia are associated with lower functional independence 90 days post-treatment despite successful recanalization.

中文翻译：

---

在多中心注册研究中，急性缺血性卒中患者接受血管内治疗后无效的再通的预测指标。

背景

无意义的再通，被定义为不能改善神经系统预后的闭塞动脉的早期再通，仍然是急性缺血性卒中的血管内治疗中持续存在的问题。在一项全国性的多中心卒中登记研究中，我们调查了血管内治疗后无效再通的发生率和预测因素。

方法

受试者包括血管内治疗急性缺血性卒中合作组登记研究（2015-2017年）的合格患者。通过血管内治疗成功完成血管造影再通（定义为2b或3级脑梗死的改良溶栓）的急性前大血管闭塞受试者被分为无效的再通管组（改良的Rankin量表评分为3–6）和根据90天的功能独立性，进行了有利的再通气治疗组（改良的Rankin量表评分为0–2）。进行逻辑回归分析以调查无效的再通的预测因素。

结果

在403例患者中，有200例（49.6％）观察到无效的再通。在多变量分析中，年龄较大（> 74 vs.≤74；比值比（OR）为2.41； 95％置信区间（CI）为1.31-4.44；P = 0.005），基线较高的美国国立卫生研究院卒中量表评分（> 21 vs.≤13； OR，2.52； 95％CI，1.21-5.28；P = 0.014），延迟穿刺至再次通气时间（> 80vs.≤80min； OR，2.75； 95％CI，1.67-4.51；P = 0.000），而全身麻醉（OR，1.90； 95％CI，1.15-3.14；P = 0.012）与机械性血栓切除术后无效的再通正相关。

结论

在亚洲人前循环阻塞患者中，进行血管内治疗后，无效的再通发生率很常见。高龄，基线较高的美国国立卫生研究院卒中量表评分，穿刺至再灌注延迟以及使用全身麻醉与治疗后90天内尽管重新通畅成功而降低了功能独立性相关。