Deans' stroke musings: Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, December 1, 2023

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

So you're predicting failure. What the fuck is your solution to prevent that failure? You're supposed to solve problems, not just describe them. I'd fire all of you for running away from the problem. COWARDS!

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

Yu Sun¹

Eric Jou²

Thanh N. Nguyen³

Mohammad Mofatteh⁴

Qingjia Liang^1,5

Mohamad Abdalkader⁶

Zile Yan¹

Mingzhu Feng¹

Xinyuan Li^7,8

Guilan Li¹

Lanzhu Luo¹

Yuzheng Lai⁹

Shuiquan Yang¹

Sijie Zhou¹⁰

Zhiming Xu^11,12^*

Xiaodong Cai^13,14^*

Yimin Chen^1,15^*

¹Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, China
²Kellogg College, University of Oxford, Oxford, United Kingdom
³Department of Neurology, Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
⁴School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
⁵Department of Internal Medicine, Foshan Sanshui District People's Hospital, Foshan, China
⁶Department of Radiology, Boston University Chobanian & Avedsian School of Medicine, Boston, MA, United States
⁷The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
⁸Medical Intern, Foshan Sanshui District People's Hospital, Foshan, China
⁹Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, China
¹⁰Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, China
¹¹Advanced Stroke Center Management Committee, Foshan Sanshui District People's Hospital, Foshan, China
¹²Dean Office, Foshan Sanshui District People's Hospital, Foshan, China
¹³Department of NeurologyThe Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
¹⁴Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
¹⁵Neuro International Collaboration (NIC), Foshan, China

Background and objectives: Endovascular thrombectomy (EVT) improves long-term outcomes and decreases mortality in ischemic stroke patients. However, a significant proportion of patients do not benefit from EVT recanalization, a phenomenon known as futile recanalization or reperfusion without functional independence (RFI). In this study, we aim to identify the major stroke risk factors and patient characteristics associated with RFI.

Methods: This is a retrospective cohort study of 297 consecutive patients with ischemic stroke who received EVT at three academic stroke centers in China from March 2019 to March 2022. Patient age, sex, modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS), Alberta stroke program early CT score (ASPECTS), time to treatment, risk factors and comorbidities associated with cerebrovascular diseases were collected, and potential associations with futile recanalization were assessed. RFI was successful reperfusion defined as modified thrombolysis in cerebral infarction (mTICI) ≥ 2b without functional independence at 90 days (mRS ≥ 3).

Results: Of the 297 initial patients assessed, 231 were included in the final analyses after the application of the inclusion and exclusion criteria. Patients were divided by those who had RFI (n = 124) versus no RFI (n = 107). Older age (OR 1.041, 95% CI 1.004 to 1.073; p = 0.010), chronic kidney disease (OR 4.399, 0.904–21.412; p = 0.067), and higher 24-h NIHSS (OR 1.284, 1.201–1.373; p < 0.001) were independent predictors of RFI. Conversely, an mTICI score of 3 was associated with a reduced likelihood of RFI (OR 0.402, 0.178–0.909; p = 0.029).

Conclusion: In conclusion, increased age, higher 24-h NIHSS and lack of an mTICI score of 3 were independently associated with RFI and have potential prognostic values in predicting patients that are less likely to respond to EVT recanalization therapy.