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. 2025 Feb;58(2):232-242.
doi: 10.1007/s11239-025-03070-w. Epub 2025 Feb 15.

Predictors of futile recanalization after intravenous thrombolysis in stroke patients transferred for endovascular treatment

Lucio D'Anna  1   2 , Matteo Foschi  3 , Luke Dixon  4 , Francesco Bax  5 , Viva Levee  6 , Feras Fayez  6 , Lucinda Knight  6 , Arianna Cella  7 , Alessandro Mare'  7 , Fedra Kuris  7 , Sara Pez  7 , Massimo Sponza  8 , Kyriakos Lobotesis  4 , Thanh Nguyen  9 , Simona Sacco  3 , Gian Luigi Gigli  8 , Mariarosaria Valente  8 , Soma Banerjee #  6   10 , Giovanni Merlino #  7 ; Study Investigators*
Affiliations

Predictors of futile recanalization after intravenous thrombolysis in stroke patients transferred for endovascular treatment

Lucio D'Anna et al. J Thromb Thrombolysis. 2025 Feb.

Abstract

Some patients with large vessel occlusion (LVO) achieve insufficient clinical improvement (futile recanalization, FR) after intravenous thrombolysis (IVT) during inter-hospital transfer for thrombectomy, while others show good outcomes (effective recanalization, ER). This study assessed FR and ER rates among patients treated with IVT at non-thrombectomy primary stroke centers (PSCs) and aimed to identify predictors of FR. We analyzed data from two PSC registries (2016-2022). Inclusion criteria: IVT treatment, anterior circulation LVO, NIHSS ≥ 6, ASPECTS ≥ 5, and documented recanalization at thrombectomy centers. FR was defined as a 90-day poor outcome (mRS 3-6) despite LVO recanalization on initial angiography. Among 190 PSC patients with documented recanalization post-IVT, 113 (59.5%) had FR. Multivariable analysis identified age (OR = 1.03, 95%CI = 1.01-1.07, p = 0.021), NIHSS at the PSC (OR = 1.13, 95%CI = 1.05-1.22, p = 0.026), and collateral status (OR = 0.54, 95%CI = 0.39-0.75, p = 0.001) as independent predictors of FR and 90-day mortality. A model combining age, NIHSS, and collateral score provided the highest predictive accuracy for FR and mortality. FR is common in LVO-related ischemic stroke treated with IVT at non-thrombectomy centers. FR is common in LVO-related ischemic stroke treated with IVT at non-thrombectomy centers. Identifying predictors of FR can guide clinicians in early decision-making, allowing for tailored interventions and informed discussions about expected outcomes, potentially leading to more optimized patient management.The GOTIC-VTE trial Unique identifier, jRCTs031180124; Registration date, April 06, 2017.

Keywords: Collateral circulation; Futile recanalization; Hub; Intravenous thrombolysis; Mechanical thrombectomy; Spoke.

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Conflict of interest statement

Declarations. Conflict of interest: SB is a key opinion leader for RAPIDAI. All other authors have no conflicts of interests. Ethical approval: This study has obtained approval from the UK Health Regulator Authority (HRA) (HRA Reference No.: 275260). The study has also received confirmation of capacity and capability from the Imperial College Healthcare NHS Trust. Informed consent: Informed consent was not a legal requirement as the research was carried out using data collected as part of routine care and any researchers outside the direct care team only had access to anonymized data.

Figures

Fig. 1
Fig. 1
Study algorithm. EVT Endovascular treatment, RC recanalization, LVO large vessel occlusion, IVT intravenous thrombolysis, FR futile recanalization, EF effective recanalization
Fig. 2
Fig. 2
Collateral score distribution. FR Futile recanalization, EF effective recanalization
Fig. 3
Fig. 3
ROC curves to predict futile recanalization and death at 90-days
See this image and copyright information in PMC

References

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