Predictors of Futile Recanalization after Endovascular Treatment of Acute Ischemic Stroke

Published in the June 2024 issue of Neurology by Wang et al.

Introduction

Endovascular therapy (EVT) has shown remarkable success in treating acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) in the anterior circulation of the brain. However, despite this success, futile recanalization (FR) continues to be a major concern impacting patient outcomes. Researchers conducted a retrospective study to identify factors associated with FR after EVT in patients with AIS with LVO.

Study Details and Results

The study enrolled patients with anterior circulation LVO and AIS who underwent EVT between June 2020 and October 2022. Patients who achieved successful reperfusion, as measured by a modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3 score but still had a poor prognosis (modified Rankin Scale (mRS) score ≥3 points) were classified as experiencing FR. The study included 196 patients: 57 in the control group with mRS <3 points and 139 in the FR group with mRS ≥3 points.

Factors Associated with Futile Recanalization

The following factors were compared in the study:

Demographics and comorbidities

Age, hypertension, diabetes, atrial fibrillation, and smoking were taken into consideration. Results showed higher rates of age, hypertension, and diabetes in the FR group.

Stroke details

National Institutes of Health Stroke Scale (NIHSS) score and Alberta Stroke Program Early CT Score (ASPECTS) were considered. The median NIHSS score was higher in the FR group.

Procedure specifics

Thrombectomy type, mTICI score, procedure duration, and onset-to-recanalization time were evaluated. The procedure duration was higher in the FR group.

Laboratory markers

Lymphocytes, neutrophils, monocytes, C-reactive protein, cholesterol, triglycerides, and ratios such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), lymphocyte-to-monocyte ratio (LMR), lymphocyte-to-C-reactive protein ratio (LCR), and lymphocyte-to-hemoglobin ratio (LHR) were measured. Results showed lower lymphocyte count, LMR, and LCR in the FR group than in the control group. Conversely, the neutrophil count and NLR were higher in the FR group.

Independent Predictors of Futile Recanalization

Multivariate logistic regression analysis identified high NLR as an independent predictor of FR after EVT in AIS patients with anterior LVO (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.005–1.86; P = .046). Investigators identified high NLR levels as an indicator of FR after EVT in patients with AIS and anterior LVO. This insight may help in future therapeutic development and risk stratification for AIS patients undergoing EVT.

Conclusion

FR remains a major concern impacting patient outcomes following EVT for AIS patients with anterior LVO. Strokes are highly complex, and the identification of independent predictors such as high NLR is of great value for preventing this complication. By identifying high NLR levels, clinicians could help to improve the outcomes of AIS patients undergoing EVT. Further research is necessary to explore other factors that may influence FR.

Originally Post From https://www.physiciansweekly.com/factors-predicting-ineffective-recanalization-in-ais-for-post-endovascular-stroke-therapy/

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