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Ischemic Lesion Net Water Uptake Outperforms ASPECTS and CBF Less Than 30% in Predicting Futile Recanalization after
Dhairya A Lakhani1,2, Hamza Adel Salim1,2,3, Vivek Yedavalli2
1Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV.
Radiology
|June 16, 2026
Summary
Net water uptake (NWU) on CT scans predicts futile recanalization (FR) in acute ischemic stroke (AIS) patients after endovascular thrombectomy (EVT). NWU outperformed other imaging markers in predicting poor outcomes despite successful reperfusion.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Net water uptake (NWU) is a CT biomarker for cerebral edema in acute ischemic stroke (AIS) with large vessel occlusion (LVO).
- Its predictive performance for futile recanalization (FR) compared to other imaging markers is uncertain.
Purpose of the Study:
- To assess the association between NWU and FR in AIS patients with LVO.
- To compare the predictive power of NWU against ASPECTS and CTP-derived rCBF30 volume for FR.
Main Methods:
- Retrospective study of 530 AIS patients with LVO who achieved successful reperfusion after EVT.
- NWU and ASPECTS measured on admission CT; rCBF30 volume derived from CTP.
- FR defined as modified Rankin Scale score 3-6 at 90 days; logistic regression and ROC analysis used for prediction.
Main Results:
- FR occurred in 58.9% of patients (312/530).
- Median NWU was significantly higher in patients with FR (7.77% vs 2.75%, P < .001).
- Adjusted models showed NWU (OR, 1.72), rCBF30 volume (OR, 1.01), and ASPECTS (OR, 0.79) were associated with FR. NWU demonstrated superior discriminative performance (AUC, 0.89) compared to rCBF30 volume (AUC, 0.66) and ASPECTS (AUC, 0.65).
Conclusions:
- Admission CT NWU is a significant predictor of FR after EVT in AIS patients with LVO.
- NWU outperforms rCBF30 volume and ASPECTS in predicting FR, offering a more accurate prognostic biomarker.
