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Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial

  • Interventional Neuroradiology
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Abstract

Purpose

The phenomenon of futile recanalization, defined as lack of clinical benefit despite angiographic recanalization, is an important limitation of endovascular treatment for acute ischemic stroke. We aim to characterize the occurrence and predictors of futile recanalization in the endovascular arm of the Interventional Management of Stroke (IMS) III trial.

Methods

Patients with near complete or complete recanalization (TICI grades 2b and 3) were divided according to functional outcome at 3 months into “meaningful recanalization,” defined as mRS score 0–2, and “futile recanalization,” mRS score 3–6. Multivariate analysis was performed to identify predictors of futile recanalization.

Results

Futile recanalization was observed in 61 (47%) of 130. Compared to meaningful recanalization group, the futile recanalization group had higher proportion of women (62.3 vs. 43.5%; p = 0.032), higher incidence of diabetes mellitus (29.5 vs. 8.7%; p = 0.004) and coronary artery disease (27.9 vs. 13%; p = 0.05), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (median [range] 19 [11–31] vs. 15 [8–26], p < 0.001), higher baseline serum glucose (7.6 ± 2.6 vs. 6.7 ± 1.7 mmol/L; p = 0.039), and longer onset-to-start of endovascular treatment time (265.8 ± 48.3 vs. 239.2 ± 47.7 min; p = 0.007). In multivariate analysis, NIHSS (OR 1.3; 95% CI 1.1–1.4), female gender (OR 3.0; 95% CI 1.1–8.2), and onset-to-start of endovascular treatment time (OR 1.2; 95% CI 1.1–1.3) were independent predictors of futile recanalization.

Conclusion

In IMS III, futile recanalization was common. Delay in endovascular treatment is the only modifiable risk factor. Additional strategies for non-modifiable risk factors—female gender and high NIHSS—need to be identified.

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Authors and Affiliations

  1. Regions Hospital Comprehensive Stroke Center, 640 Jackson St, St Paul, MN, 55101, USA

    Haitham M. Hussein

  2. Zeenat Qureshi Stroke Institute, St Cloud, MN, USA

    Muhammad A. Saleem & Adnan I. Qureshi

Authors
  1. Haitham M. Hussein
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  2. Muhammad A. Saleem
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  3. Adnan I. Qureshi
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Correspondence to Haitham M. Hussein.

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Funding

No funding was received for this study.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study; however, additional consent was not obtained for post hoc analysis.

Electronic supplementary material

Supplementary figure e1

Modified Rankin scale distribution among two study groups: meaningful and futile rencalalization, as well as patients who did not experience any recanalization (PDF 53 kb).

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Hussein, H.M., Saleem, M.A. & Qureshi, A.I. Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial. Neuroradiology 60, 557–563 (2018). https://doi.org/10.1007/s00234-018-2016-2

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  • DOI: https://doi.org/10.1007/s00234-018-2016-2

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