Predictors of futile recanalisation in patients with large infarct: a post-hoc analysis of the ANGEL-ASPECT trial
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 Thi...
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| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2025/07/06/svn-2024-003382.full |
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| author | Zhongrong Miao Xiaochuan Huo Wenhuo Chen Yuesong Pan Mengxing Wang Tingyu Yi Xiufen Zheng Yan-min Wu Ding-lai Lin Xiaohui Lin Zhinan Pan |
| author_facet | Zhongrong Miao Xiaochuan Huo Wenhuo Chen Yuesong Pan Mengxing Wang Tingyu Yi Xiufen Zheng Yan-min Wu Ding-lai Lin Xiaohui Lin Zhinan Pan |
| author_sort | Zhongrong Miao |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-bc78e53636a24849beea0eca000a2ea3 |
| institution | DOAJ |
| issn | 2059-8696 |
| language | English |
| publisher | BMJ Publishing Group |
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| series | Stroke and Vascular Neurology |
| spelling | doaj-art-bc78e53636a24849beea0eca000a2ea32025-08-20T02:43:39ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2024-003382Predictors of futile recanalisation in patients with large infarct: a post-hoc analysis of the ANGEL-ASPECT trialZhongrong Miao0Xiaochuan Huo1Wenhuo Chen2Yuesong Pan3Mengxing Wang4Tingyu Yi5Xiufen Zheng6Yan-min Wu7Ding-lai Lin8Xiaohui Lin9Zhinan Pan10Neurology and Neuroradiology, Beijing Tiantan Hospital, Beijing, Beijing, ChinaDepartment of Interventional Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, Beijing, ChinaDepartment of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, Beijing, ChinaDepartment of Neurology, Beijing Tiantan Hospital, Beijing, Beijing, ChinaNeurology Department, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, ChinaZhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, ChinaNeurology Department, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, ChinaNeurology Department, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, ChinaZhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, ChinaZhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, ChinaBackground 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.https://svn.bmj.com/content/early/2025/07/06/svn-2024-003382.full |
| spellingShingle | Zhongrong Miao Xiaochuan Huo Wenhuo Chen Yuesong Pan Mengxing Wang Tingyu Yi Xiufen Zheng Yan-min Wu Ding-lai Lin Xiaohui Lin Zhinan Pan Predictors of futile recanalisation in patients with large infarct: a post-hoc analysis of the ANGEL-ASPECT trial Stroke and Vascular Neurology |
| title | Predictors of futile recanalisation in patients with large infarct: a post-hoc analysis of the ANGEL-ASPECT trial |
| title_full | Predictors of futile recanalisation in patients with large infarct: a post-hoc analysis of the ANGEL-ASPECT trial |
| title_fullStr | Predictors of futile recanalisation in patients with large infarct: a post-hoc analysis of the ANGEL-ASPECT trial |
| title_full_unstemmed | Predictors of futile recanalisation in patients with large infarct: a post-hoc analysis of the ANGEL-ASPECT trial |
| title_short | Predictors of futile recanalisation in patients with large infarct: a post-hoc analysis of the ANGEL-ASPECT trial |
| title_sort | predictors of futile recanalisation in patients with large infarct a post hoc analysis of the angel aspect trial |
| url | https://svn.bmj.com/content/early/2025/07/06/svn-2024-003382.full |
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