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

Tingyu Yi; Xiaochuan Huo; Xiaohui Lin; Mengxing Wang; Yan-Min Wu; Zhinan Pan; Xiufen Zheng; Ding-Lai Lin; Yuesong Pan; Zhongrong Miao; Wenhuo Chen

doi:10.1136/svn-2024-003382

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

Stroke Vasc Neurol. 2025 Jul 6:svn-2024-003382. doi: 10.1136/svn-2024-003382. Online ahead of print.

Authors

Tingyu Yi^{1

2}, Xiaochuan Huo³, Xiaohui Lin⁴, Mengxing Wang^{5

6}, Yan-Min Wu⁴, Zhinan Pan⁴, Xiufen Zheng⁴, Ding-Lai Lin⁴, Yuesong Pan^{6

7}, Zhongrong Miao⁸, Wenhuo Chen^{9

10}

Affiliations

¹ Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
² Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, Beijing, China.
³ Department of Interventional Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, Beijing, China.
⁴ Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
⁵ Department of Neurology, Beijing Tiantan Hospital, Beijing, Beijing, China.
⁶ China National Clinical Research Center for Neurological Diseases, Beijing, Beijing, China.
⁷ China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, Beijing, China.
⁸ Neurology and Neuroradiology, Beijing Tiantan Hospital, Beijing, Beijing, China.
⁹ Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China 13806906089@126.com.
¹⁰ Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, Fujian, China.

PMID: 40623733
DOI: 10.1136/svn-2024-003382

Abstract

Background: Studies on futile recanalisation after endovascular therapy (EVT) for anterior circulation large vessel occlusion with large infarct were scarce. The present study aimed to explore the incidence and independent predictors of futile recanalisation in patients with large infarct.

Methods: This is a post-hoc analysis of the ANGEL-Alberta Stroke Program Early CT (ASPECT) trial. A favourable outcome was defined as a 90-day modified Rankin Scale score of 0-3; successful reperfusion was defined as extended thrombolysis in cerebral infarction 2b, 2c and 3 on final angiogram; and futile recanalisation was defined as unfavourable outcome despite successful reperfusion. We performed multivariate analysis to identify the predictors of futile recanalisation after EVT in patients with large infarct.

Results: A total of 183 patients were included: 91 (49.7%) patients had futile recanalisation and 92 (51.3%) had meaningful recanalisation. In multivariable logistic regression analysis, nonmodifiable factors included older age (age ≥68 years, OR=3.4, 95%CI 1.5 to 7.7, p= 0.003), female sex (OR=2.78, 95%CI 1.28 to 7.27, p=0.01), higher National Institutes of Health Stroke Scale score (NIHSS ≥16, OR=3.1, 95%CI 1.2 to 8.3, p=0.035), diabetes (OR=3.1, 95%CI 1.2 to 8.3, p=0.017) and symptomatic intracranial haemorrhage (sICH) (OR=9.1, 95%CI 1.0 to 80.7, p=0.049), and modifiable factors included larger final infarct volume (FIV ≥174.7, OR=6.2, 95%CI 2.5 to 15.7, p<0.001) and postoperative respiratory failure (OR=14.1, 95%CI 1.6 to 124.8, p=0.018), which were independent predictors of futile recanalisation.

Conclusions: Futile recanalisation occurred in approximately half of patients who had an acute stroke with large infarct after EVT in the ANGEL-ASPECT trial. Nonmodifiable factors that included old age, high baseline NIHSS score, diabetes mellitus, sICH and large FIV, and modifiable factors that included respiratory failure were independent predictors of futile recanalisation after EVT for large ischaemic strokes. Stroke-related pneumonia control may improve prognosis.

Keywords: Brain; Cerebral Infarction; Cerebrovascular Disorders.