Background: Few studies have focused on factors associated with futile recanalization in patients with an acute basilar artery occlusion (BAO) that was treated with modern endovascular therapy (EVT). The aim of this study was to explore the factors associated with futile recanalization in patients with an acute BAO presented within 12 h.
Methods: This is a post-hoc analysis of the ATTENTION trial (The Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion, ClinicalTrials.gov, number NCT04751708). Demographics, clinical characteristics, acute stroke workflow interval times, and imaging characteristics were compared between the futile recanalization and favorable recanalization groups. The favorable outcome was defined as a modified Rankin scale (mRS) score of 0-3 at 90 days, successful reperfusion was defined as thrombolysis in cerebral infarction (TICI) 2b and 3 on the final angiogram, and futile recanalization was defined as failure to achieve a favorable outcome despite successful reperfusion. A multivariate analysis was performed to identify the predictors of futile recanalization.
Results: In total, 185 patients were included in the final analysis: 89 (48.1%) patients had futile recanalization and 96 (51.9%) patients had favorable recanalization. In the multivariable logistic regression analysis, older age (OR 1.04, 95% CI 1.01 to 1.08, = 0.01) and diabetes mellitus (OR 3.35, 95% CI 1.40 to 8.01, = 0.007) were independent predictors of futile recanalization.
Conclusion: Futile recanalization occurred in nearly half of patients with acute BAO following endovascular treatment. Old age and diabetes mellitus were identified as independent predictors of futile recanalization after endovascular therapy for acute BAO.
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http://dx.doi.org/10.3389/fneur.2023.1308036 | DOI Listing |
J Neuroimaging
January 2025
Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
Introduction: The venous outflow profile (VOP) is a crucial yet often overlooked aspect affecting stroke outcomes. It plays a major role in the physiopathology of acute cerebral ischemia, as it accounts for both the upstream arterial collaterals and cerebral microperfusion. This enables it to circumvent the limitations of various arterial collateral evaluation systems, which often fail to consider impaired autoregulation and its impact on cerebral blood flow at the microcirculatory levels.
View Article and Find Full Text PDFJ Neurosci Res
January 2025
Luhe Institute of Neuroscience, Capital Medical University, Beijing, China.
Despite significant advancements in achieving high recanalization rates (80%-90%) for large vessel occlusions through mechanical thrombectomy, the issue of "futile recanalization" remains a major clinical challenge. Futile recanalization occurs when over half of patients fail to experience expected symptom improvement after vessel recanalization, often resulting in severe functional impairment or death. Traditionally, this phenomenon has been attributed to inadequate blood flow and reperfusion injury.
View Article and Find Full Text PDFAcad Radiol
December 2024
Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China (C.G., S.J., L.H., Z.W., Y.C., Z.H., J.L., J.Y., Y.W., S.G., Y.C., T.X.). Electronic address:
Rationale And Objectives: The correlation between collateral circulation and futile recanalization (FR) is still controversial, and few studies have explored the influence of comprehensive cerebral collateral circulation on FR after endovascular stroke treatment. Therefore, based on cerebral collateral recycle (CCR) status, we aimed to establish an effective scoring system to identify the probability of FR.
Methods: This was a multicenter retrospective cohort study.
Stroke
January 2025
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (N.H., T.H., M.K., H.K., D.I.).
Background: Thrombectomy for acute large vessel occlusion is a well-established treatment for stroke prevention. However, futile recanalization cases, where no-reflow occurs despite successful recanalization, have been reported. This study aimed to assess cerebral hemodynamics immediately after thrombectomy and their relationship with clinical outcomes.
View Article and Find Full Text PDFClin Interv Aging
November 2024
Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China.
Background And Purpose: Many patients who gained successful recanalization by endovascular treatment (EVT) with acute large vessel occlusion (LVO) did not have the favorable outcome. The study aimed to assess the association between H-type hypertension and clinical prognosis in patients with LVO after receiving EVT.
Methods: Our study enrolled patients from the Endovascular Treatment With versus Without Tirofiban for Stroke Patients with Large Vessel Occlusion (RESCUE BT) Trial.
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