Predictors and outcome metrics of futile recanalization in patients with acute ischemic stroke

Background Previous studies have demonstrated that successful reperfusion does not always correlate with long-term functional benefit in patients with acute ischemic stroke (AIS) treated via endovascular therapy (EVT). We evaluated patient characteristics and clinical outcomes in patients with AIS who underwent EVT with successful reperfusion resulting in either beneficial recanalization (BR) or futile recanalization (FR). Methods The authors conducted a single-institution retrospective, observational study of patients with AIS who underwent EVT between January 2019 and January 2024. Baseline characteristics, procedural details, and clinical metrics were reviewed, and FR predictors were identified. Results Of 441 subjects, 151 (34.24%) experienced FR, with this cohort displaying a higher mean blood glucose level on admission compared with the BR cohort (168±87.77 mg/dL vs 143±70.48 mg/dL; P=0.0029). Multivariable logistic regression analysis found blood glucose on admission to be a significant independent predictor of FR (P=0.0081). Hyperglycemia (glucose≥126 mg/dL) carried a twofold higher risk of FR (OR 2.088, 95% CI 1.399 to 3.137, P=0.0003), whereas glucose exceeding 300 mg/dL carried a threefold increased risk (OR 3.321, 95% CI 1.367 to 8.565, P=0.0093). Conclusions Rates of futile recanalization increased in a stepwise fashion as glucose levels on admission worsened in this study cohort. These findings suggest that early and rapid glucose management in patients with AIS undergoing EVT may improve outcomes and reduce the incidence of futile recanalization.