Association between Angiography-Based Hemodynamic Features and Futile Recanalization in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

BACKGROUND AND PURPOSE:

Despite successful recanalization, some patients with acute ischemic stroke remain functionally dependent, which is referred to as futile recanalization (FR). While inadequate perfusion is linked to poor outcomes, hemodynamics (especially time to peak) measured by quantitative DSA immediately post-thrombectomy are underexplored. TTP is defined as the time from contrast injection to peak density at the ROI, indicating perfusion status. Therefore, we investigated the association between TTP and FR.

MATERIALS AND METHODS:

We retrospectively screened patients with anterior circulation acute ischemic stroke who underwent mechanical thrombectomy with successful recanalization from prospective multicenter databases. Post-thrombectomy DSA sequences were imported into the prototype software to generate color-coded quantitative DSA images. Four ROIs were delineated at specific anatomic locations: the ICA C2 and C6 segments and the MCA M1 and M2 segments. TTP values for each ROI were obtained, with the TTP value of ROI_C2 serving as a reference for calculating the relative TTP values. Futile recanalization was defined as successful recanalization without functional independence (90-day mRS 0–2). Multivariate logistic regression was used to assess the relationships between hemodynamic parameters and FR or other clinical outcomes, supplemented by sensitivity and subgroup analyses.

RESULTS:

In total, 425 patients (median [interquartile range] age, 68 [58–75] years, 60.0% men) were included. Among these patients, 52.7% experienced FR. When the relative post-thrombectomy TTP_C2-M1 (TTP_M1–TTP_C2) was prolonged, patients were more likely to have FR (adjusted OR 1.956; 95% CI: 1.245 to 3.074; P =.004), as well as symptomatic intracranial hemorrhage, early neurologic deterioration, and delayed neurologic improvement (all P < .05).

CONCLUSIONS:

The relative TTP_C2-M1, namely, the large artery circulation time, was prolonged in patients with FR or other negative outcomes. The prolonged relative TTP was suggestive of reduced cerebral blood flow velocity, thereby increasing the risk of insufficient perfusion and serving as an important risk factor for poor prognosis.