Echocardiographic predictors of futile recanalization in acute ischemic stroke

The aim of the study was to investigate the relationship between echocardiographic parameters and clinical outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy, aiming to identify predictors of poor prognosis despite successful recanalization.

This retrospective, single-center study included 320 acute ischemic stroke patients treated with mechanical thrombectomy for large vessel occlusion. Demographic, clinical, and echocardiographic data were collected. Univariable and multivariable logistic regression and receiver operating characteristic analyses were used. Futile recanalization was defined as achieving modified Thrombolysis in Cerebral Infarction 2b-3 with a poor functional outcome (mRS 3-6).

Of the 320 patients, 176 (55%) were classified as favorable and 144 (45%) as futile recanalization. The futile group had a higher mean age (77.3±12.7 vs. 67.6±12.8; p<0.001), National Institutes of Health Stroke Scale score (median 17 vs. 14; p=0.007), and puncture-to-recanalization time (47.5 vs. 30 min; p=0.017), and lower Alberta Stroke Program Early Computed Tomography score (7.5 vs. 10; p<0.001). Echocardiographically, they had lower left ventricular ejection fraction (55 vs. 57.5%; p=0.036) and larger left ventricular end-diastolic diameter (4.8 vs. 4.5 cm; p=0.002). Multivariable analysis identified low Alberta Stroke Program Early Computed Tomography score (OR 0.192; p=0.002), high National Institutes of Health Stroke Scale (OR 1.212; p=0.029), and low left ventricular ejection fraction (OR 0.919; p=0.047) as independent predictors. Alberta Stroke Program Early Computed Tomography had the highest predictive value (area under the curve : 0.851), followed by left ventricular ejection fraction (area under the curve: 0.631), while National Institutes of Health Stroke Scale showed lower predictive power (area under the curve: 0.326).

Poor outcomes after mechanical thrombectomy are associated with low Alberta Stroke Program Early Computed Tomography scores, high National Institutes of Health Stroke Scale, and reduced left ventricular ejection fraction. Echocardiographic evaluation, particularly of left ventricular ejection fraction, may aid in prognostication and treatment planning in acute ischemic stroke.