A pre-intervention six-item scale for predicting futile recanalization after endovascular therapy in patients with acute ischemic stroke with large core infarction

作者：Yawen Gan, Jie He, Zhongao Guan, Ketao Tu, Fangguang Chen, Shuang Song, Dingwen Zhang, Yuesong Pan, Zhongrong Miao, Dapeng Mo, Xu Tong · 发表于：Journal of NeuroInterventional Surgery · 年份：2025 · DOI：10.1136/jnis-2025-023370 · 被引用次数：5 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Intracerebral and Subarachnoid Hemorrhage Research

BACKGROUND: Despite successful reperfusion after endovascular therapy (EVT), over 50% of patients with large vessel occlusion (LVO) and large core infarction fail to achieve favorable functional outcomes, termed 'futile recanalization'. This study aimed to identify predictors and develop a scoring system to predict futile recanalization in patients with LVO and large core infarction undergoing EVT. METHODS: Patients were selected from the Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core (ANGEL-ASPECT) trial. Futile recanalization was defined as a modified Rankin Scale (mRS) score of >3 at 90 days despite successful reperfusion (extended Thrombolysis in Cerebral Infarction scale ≥2b). Participants were divided into futile (mRS >3) and no-futile (mRS ≤3) recanalization groups. Multivariable logistic regression was used to develop the predictive scale, with model performance assessed via a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test. RESULTS: Of 146 patients, 74 had futile recanalization. A six-item scale (0-6 points) was developed, including gender, age, systolic blood pressure, admission National Institutes of Health Stroke Scale score, blood glucose, and neutrophil-to-lymphocyte ratio. The scale showed good predictive performance (area under the ROC curve (AUC) 0.806, 95% CI 0.737 to 0.876) and good calibration (Hosmer-Lemeshow test, P=0.837). The optimal cut-off value of the scale was ≥3 points with 81% sensitivi...