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

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. Result 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. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial ClinicalTrials.gov number [NCT04551664][1] ### Funding Statement This work was supported by National Health Commission Capacity Building and Continuing Education Center, grant number GWJJ2021100203, Natural Science Foundation of Fujian Province (Grant No. 2022J01123138). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committee of Zhangzhou Affiliated Hospital of Fujian Medical University Zhangzhou Municipal Hospital Ethics Committee I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available on request from the corresponding author. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04551664&atom=%2Fmedrxiv%2Fearly%2F2023%2F09%2F23%2F2023.09.19.23295812.atom