Predictors of futile recanalization in completely recanalized middle cerebral artery occlusions: multicenter study
Özet
Background: Endovascular thrombectomy (EVT) improves outcomes and reduces mortality in acute ischemic stroke. However, despite achieving successful recanalization in most patients, a subset still experiences poor functional outcomes at 3 months. This failure, despite complete vessel reopening, is termed futile recanalization (FR). We investigated clinical and radiological predictors of FR in a multicenter cohort in Türkiye. Methods: We retrospectively analyzed 497 consecutive patients with middle cerebral artery (M1 or M2) occlusion who underwent EVT and achieved modified Thrombolysis in Cerebral Infarction (mTICI) 3 recanalization within 6 h of symptom onset at 19 stroke centers. FR was defined as a modified Rankin Scale (mRS) score ≥4 at 3 months. Clinical and radiological parameters were recorded, and logistic regression was used to identify independent predictors of FR. Results: Among 497 patients, 133 (26.7%) experienced FR despite complete recanalization. Independent predictors included older age (adjusted odds ratio [aOR] 1.07; 95% CI 1.03–1.10; p < 0.001), longer puncture-to-recanalization time (aOR 1.03; 95% CI 1.02–1.05; p < 0.001), higher admission C-reactive protein (aOR 1.01; 95% CI 1.00–1.02; p = 0.03), intracranial hemorrhage on 24-h CT (aOR 0.46; 95% CI 0.23–0.95; p = 0.04), lower collateral score (aOR 42.98; 95% CI 6.15–30.62; p < 0.001), and higher 24-h NIHSS score (aOR 1.34; 95% CI 1.24–1.44; p < 0.001). Conclusion: Even with early and complete recanalization, elderly patients and those with poor collateral circulation remain at risk for futile recanalization. Identifying these predictors can guide patient selection, procedural planning, and post-procedural management to optimize functional outcomes.
Anahtar kelimeler
Atıf için künye
Memiş, Z., Gürkaş, E., ÖZDEMİR, A. Ö., Acar, B. A., Ögün, M. N., Aytaç, E., AKPINAR, Ç. K., Önalan, A., Akıl, E., Çabalar, M., Özkul, A., Görgülü, Ü., Bayındır, H., Mehdiyev, Z., Delibaş Katı, Ş., Baydemir, R., Yabalak, A., Aykaç, Ö., Uysal Kocabaş, Z., … Asil, T. (2026). Predictors of futile recanalization in completely recanalized middle cerebral artery occlusions: multicenter study. Frontiers in Neurology, 17. https://doi.org/10.3389/fneur.2026.1754255
BibTeX
@article{memis2026-229049,
author = {Memiş, Zülfikar and Gürkaş, Erdem and ÖZDEMİR, ATİLLA ÖZCAN and Acar, Bilgehan Atılgan and Ögün, Muhammed Nur and Aytaç, Emrah and AKPINAR, ÇETİN KÜRŞAD and Önalan, Ayşenur and Akıl, Eşref and Çabalar, Murat and Özkul, Ayça and Görgülü, Ümit and Bayındır, Hasan and Mehdiyev, Zaur and Delibaş Katı, Şennur and Baydemir, Recep and Yabalak, Ahmet and Aykaç, Özlem and Uysal Kocabaş, Zehra and Yıldırım, Serhan and Doğan, Hasan and Arı, Mehmet Semih and Çetiner, Mustafa and Balgetir, Ferhat and Eren, Fettah and Eren, Alper and Kızıldağ, Nazım and Çenikli, Utku and Şişman Bayar, Aysel Büşra and Temel, Ebru and Eryılmaz, Halil Alper and Aksu, Semanur and Saygın Uysal, Emine and Gültekin, Hamza and Durmaz, Cebrail and Bayar, Muhammet Duran and Akan, Onur and Boncuk Ulaş, Sena and Asil, Talip},
title = {Predictors of futile recanalization in completely recanalized middle cerebral artery occlusions: multicenter study},
journal = {Frontiers in Neurology},
year = {2026},
volume = {17},
issn = {1664-2295},
doi = {10.3389/fneur.2026.1754255},
url = {https://akademik.atauni.edu.tr/yayinlar/229049-predictors-of-futile-recanalization-in-completely-recanalized-middle-cerebral}
}