Recanalización fútil tras trombectomía mecánica en pacientes con ictus isquémico agudo y núcleo isquémico grande

Multiple randomized controlled trials have demonstrated the efficacy of mechanical thrombectomy (MT) for acute ischemic stroke with a large ischemic core caused by large-vessel occlusion. Despite successful recanalization, more than half of the patients do not achieve a favorable prognosis, a phenomenon referred to as futile recanalization (FR). We aimed to identify the risk factors for, and incidence of, FR in patients with large ischemic cores.

Eighty-four patients with a large ischemic core who underwent MT between January 2015 and December 2024 at three hospitals were retrospectively reviewed. Patients were divided into two groups-FR and no-FR-according to functional independence at 90 days (modified Rankin Scale (mRS) score ≥4). Factors influencing FR were identified using multivariate logistic regression and receiver operating characteristic curve analyses.

Eighty-four patients fulfilled the inclusion criteria, and FR was observed in 57 patients (67.9%). Multivariable regression analysis revealed that older age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01-1.18; P=0.011), concomitant diabetes (OR, 11.2; 95% CI, 1.13-111.1; P=0.012), diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (OR, 0.32; 95% CI, 0.11-0.79; P=0.012), and an increased number of passes (OR, 1.91; 95% CI, 1.00-4.16; P=0.046) were independently associated with FR after MT.

Older age, concomitant diabetes, diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score, and an increased number of passes are independently associated with FR after MT in patients with a large ischemic core.