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Updated: Jun 25, 2026
A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model
Published on: June 4, 2021
The dynamic interplay between cerebral collateral cascade and infarct growth rate in futile recanalization after
Jiajia Yang1, Jialei Fei1, Wanyi Shao2
1Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China.
Background:
Futile recanalization (FR) remains common despite successful reperfusion after endovascular thrombectomy (EVT) for acute ischemic stroke. Although both collateral status and infarct growth rate (IGR) are established predictors of outcome, it remains unclear whether infarct growth dynamics modify the prognostic effect of collateral status.
Objective:
This study aimed to investigate the interaction between the cerebral collateral cascade (CCC) and IGR in relation to FR after successful EVT.
Method:
We retrospectively analyzed consecutive patients from two comprehensive stroke centers with anterior circulation large-vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction grade 2b-3) after EVT within 6 h of a clearly documented symptom onset. Patients with wake-up stroke or uncertain onset were excluded. Collateral status was assessed with the CCC framework, integrating pial arterial collateral, tissue-level collateral, and venous outflow. IGR was calculated as the baseline ischemic core volume divided by onset-to-imaging time. The primary outcome was futile recanalization, defined as a 90-day modified Rankin Scale (mRS) score of 3-6 despite successful reperfusion. Multivariable logistic regression was used to evaluate independent associations and the CCC×IGR interaction term.
Results:
Among 157 included patients, 70 (44.6%) experienced futile recanalization. In multivariable analysis, unfavorable CCC and higher IGR were independently associated with futile recanalization. A statistically significant interaction was observed between CCC and IGR (interaction OR, 0.863, 95% CI, 0.754-0.986; P = 0.031). In stratified analyses, favorable CCC was associated with a lower risk of futile recanalization among slow progressors (<10 mL/h)(OR, 0.152; 95%CI, 0.043-0.531; P = 0.003), but not among fast progressors (≥10mL/h)(OR, 0.460; 95% CI, 0.050-4.225; P = 0.493).
Conclusions:
The association between favorable CCC and reduced FR after successful EVT appears to be modified by IGR. Favorable CCC was associated with reduced futile recanalization primarily in slow progressors, whereas this association was attenuated in fast progressors. These preliminary findings suggest that integrating collateral status with ischemic progression metrics may provide complementary information for post-reperfusion prognostic assessment after EVT, although external validation is required.
