The following is a summary of “Predictors of futile recanalization after endovascular treatment of acute ischemic stroke,” published in the June 2024 issue of Neurology by Wang, et al.

Despite the success of endovascular therapy (EVT) for acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the front of the brain, futile recanalization (FR) remains a major concern impacting patient outcomes.

Researchers conducted a retrospective study to identify factors associated with FR after EVT in patients with AIS with LVO.

They enrolled patients with anterior circulation LVO and AIS who underwent EVT  (June 2020 and October 2022). The FR post-EVT meant a poor prognosis (mRS score ≥ 3) despite achieving successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] 2b-3). Patients were categorized into control (mRS < 3) and FR groups (mRS ≥ 3). Demographics, comorbidities (hypertension, diabetes, atrial fibrillation, smoking), stroke details (NIHSS score, ASPECT score, occlusion site), procedure specifics (thrombectomy type, mTICI score, procedure duration, onset-to-recanalization time), and laboratory markers (lymphocytes, neutrophils, monocytes, C-reactive protein, ratios like NLR, MHR, LMR, LCR, LHR, cholesterol, triglycerides) were compared. Multivariate logistic regression identified independent predictors of FR after EVT.

The results showed 196 patients, 57 of whom were in the control group and 139 in the FR group. In the FR group, age, hypertension, diabetes rates, median NIHSS score, CRP level, procedure duration, neutrophil count, and NLR were higher compared to the control group. Conversely, lymphocyte count, LMR, and LCR were lower in the FR group. No significant differences in platelet count, monocyte count, cholesterol, triglycerides, HDL, LDL, gender, smoking, atrial fibrillation, occlusion site percentage, onset-to-recanalization time, ASPECT score, and treatment type between the groups. Multivariate logistic regression analysis identified NLR as independently associated with FR after EVT (OR = 1.37, 95%CI = 1.005–1.86, P=0.046).

Investigators identified high NLR as a predictor of FR after EVT in patients with AIS with anterior LVO, potentially aiding risk stratification and future therapeutic development.

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-024-03719-8