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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. 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). 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 (  = 124) versus no RFI (  = 107). Older age (OR 1.041, 95% CI 1.004 to 1.073;  = 0.010), chronic kidney disease (OR 4.399, 0.904-21.412;  = 0.067), and higher 24-h NIHSS (OR 1.284, 1.201-1.373;  < 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;  = 0.029). 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.

Background Endovascular therapy (EVT) is the standard of care for acute ischemic stroke due to large vessel occlusion. While predictors of 90-day functional outcome are well-established, the determinants of functional recovery remain less clearly defined in the post-discharge period for patients with initial disability. We aimed to identify the predictors of functional outcome at 3 months in patients who underwent EVT and were discharged with an unmet need for recovery (modified Rankin scale (mRS) score > 2). Methods A multi-center, observational cohort study was conducted using data from the Big Data Observatory Platform for Stroke in China. We included 836 patients from eight comprehensive stroke centers (August 2018 – December 2024) who received EVT, had a pre-stroke mRS of 0–2, and had an mRS > 2 at discharge. The primary outcome was functional outcome at 3 months post-EVT, defined as an mRS score of 0–2. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Results Of the 836 patients, 151 (18.1%) achieved a favorable functional outcome (mRS 0–2) at 3 months. In univariate analysis, the favorable outcome group was significantly younger, had a lower pre-EVT NIHSS, a lower rate of atrial fibrillation, a higher rate of intravenous thrombolysis, a higher rate of complete recanalization (mTICI 3), and a lower rate of parenchymal hematoma (PH) (all p  < 0.05). Multivariate regression confirmed four independent predictors: younger age (aOR: 0.973; 95% CI: 0.958–0.989; p  = 0.001), lower pre-EVT NIHSS (aOR: 0.940; 95% CI: 0.912–0.968; p  < 0.001), complete recanalization (aOR: 1.921; 95% CI: 1.305–2.826; p  = 0.001), and absence of PH (aOR: 0.424; 95% CI: 0.235–0.768; p  = 0.005). Conclusion A significant proportion of patients discharged with disability experiences meaningful functional recovery by 3 months post-EVT. The key predictors of this subsequent recovery are younger age, milder initial stroke severity, complete reperfusion, and the avoidance of hemorrhagic complications.

Objective Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) and endovascular therapy (EVT) are established treatments for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior circulation. This study aimed to compare the safety and efficacy of bridging therapy (rt-PA before EVT) versus direct EVT in a real-world, multicenter setting. Methods In this retrospective multicenter cohort study, 724 patients with anterior circulation AIS treated with EVT within 8 h of symptom onset were analyzed. Patients received either pre-EVT rt-PA (n = 314) or direct EVT without rt-PA (n = 410). Primary outcomes included 3-month functional independence (modified Rankin Scale (mRS) 0–2), excellent outcome (mRS 0–1), and mortality. Secondary outcomes included hemorrhagic transformation, parenchymal hematoma, and successful reperfusion (mTICI ≥ 2b). Multivariate logistic regression was adjusted for key clinical confounders. Results Baseline characteristics were comparable, except for higher median NIHSS scores in the direct EVT group (16 vs. 15, p < 0.001). No significant differences were observed in 3-month functional independence (43.0% vs. 50.3%, p = 0.051), excellent outcome (36.8% vs. 42.0%, p = 0.155), or mortality (22.9% vs. 20.1%, p = 0.354). Hemorrhagic transformation and parenchymal hematoma rates were similar. Although successful reperfusion was higher in the rt-PA group (93.6% vs. 88.5%, p = 0.019), this did not remain significant after adjustment. Conclusion Pre-EVT rt-PA did not improve functional outcomes or reduce mortality in AIS patients. While rt-PA showed a trend toward higher reperfusion rates, this did not translate to clinical benefit. Hemorrhage risks were similar between groups.

Background and Aims As a safer approach for cerebral angiography, there is still a lack of further systematic research on the distal radial artery approach. To compare the safety and efficacy of the distal radial artery approach versus the conventional (proximal) radial artery approach for cerebral angiography, providing evidence for optimizing cerebrovascular disease diagnosis and treatment strategies. Methods Sixty patients with cerebrovascular disease admitted to Guangdong Integrated Traditional Chinese and Western Medicine Hospital from January 2023 to December 2024 were enrolled and randomly assigned to either the distal radial artery group (experimental group, n = 30) or the conventional radial artery group (control group, n = 30). Data on puncture time, procedure duration, contrast agent dosage, radiation dose, complication rates, and patient satisfaction were recorded. Statistical analysis was performed using SPSS 21.0. Results Baseline characteristics were comparable between the two groups (p > 0.05). No significant differences were observed in total procedure duration (total puncture time: 10 (11) vs. 8 (10.5) min, p = 0.982; puncture‐to‐procedure completion time: 50 (17.3) vs. 50 (22.3) min, p = 0.728). Contrast agent volume (135 (5.5) vs. 130 (10) mL, p = 0.051) and radiation dose (925.68 ± 274.83 vs. 899.71 ± 326.25 mGy·cm², p = 0.740) also showed no significant differences. However, the experimental group had a lower complication rate (3.33% vs. 23.33%, p = 0.023) and higher patient satisfaction (100% vs. 86.67%, p = 0.038). Conclusion The distal radial artery approach for cerebral angiography reduces complication risks and improves patient comfort, demonstrating significant clinical advantages. However, due to the single‐center design and short‐term follow‐up, further multicenter, large‐sample studies are needed to validate its long‐term benefits.

Purpose The aim of this study was to identify factors that predict favorable functional outcomes in elderly patients with large-vessel occlusion acute ischemic stroke (LVO-AIS) who underwent mechanical thrombectomy (MT). Methods We conducted a retrospective observational study using the prospectively maintained Bigdata Observatory for Stroke of China (BOSC) to identify eligible patients who underwent MT for LVO-AIS at four comprehensive stroke centers between August 2019 and February 2022. Inclusion criteria included patients aged 80 years or older with a baseline modified Rankin Scale (mRS) 0–2, baseline National Institutes of Health Stroke Scale (NIHSS) > 6, baseline Alberta Stroke Program Early CT Score (ASPECTS) > 6 who received treatment within 24 h from symptom onset. Pertinent demographic, clinical, and procedural variables were collected. Multivariable regression analyses were performed to identify predictors of favorable long-term functional outcomes, defined as mRS 0–2 at 90 days. Results A total of 63 patients were included in the study with a mean age of 83 years. Patients with previous diagnosis of atrial fibrillation were more likely to have a favorable functional outcome (OR 2.09, 95% CI 2.09–407.33, p  = 0.012), while a higher baseline NIHSS was associated with a less favorable functional outcome (OR 0.64, 95% CI 0.46–0.89, p  = 0.007). In addition, there was an observed trend suggesting an association between higher baseline ASPECTS and favorable functional outcomes. This association did not reach statistical significance (OR 2.49, 95% CI 0.94–6.54, p  = 0.065). Conclusion In this study, we identified factors that predicted a favorable functional outcome in elderly LVO-AIS patients undergoing MT. A higher baseline NIHSS decreased the odds of mRS 0–2 at 90 days, whereas a history of atrial fibrillation increased the odds of a favorable functional outcome. These results emphasize the complex relationship between clinical factors and functional recovery in this vulnerable population.

Atrial fibrillation is one of the major risk factors of ischemic stroke. Endovascular thrombectomy (EVT) has become the standard treatment for acute ischemic stroke with large vessel occlusion. However, data regarding the impact of AF on the outcome of patients with acute ischemic stroke treated with mechanical thrombectomy are controversial. The aim of our study was to determine whether atrial fibrillation modifies the functional outcome of patients with anterior circulation acute ischemic stroke receiving EVT. We reviewed 273 eligible patients receiving EVT from January 2019 to January 2022 from 3 comprehensive Chinese stroke centers, of whom 221 patients were recruited. Demographics, clinical, radiological and treatment characteristics, safety outcomes, and functional outcomes were collected. Modified Rankin scale (mRS) score ≤ 2 at 90 days was defined as a good functional outcome. In our cohort, 79 patients (35.74%) were eventually found to have AF. Patients with AF were elder (70.08 ± 11.72 vs. 61.82 ± 13.48 years, = 0.000) and less likely to be males (54.43 vs. 73.94%, = 0.03). The significant reperfusion rate (modified thrombolysis in cerebral infarction 2b-3) was 73.42 and 83.80% in patients with and without AF, respectively ( = 0.064). The good functional outcome (90-day modified Rankin scale: 0 to 2) rate was 39.24 and 44.37% in patients with and without AF, respectively ( = 0.460) after adjusting multiple confounding factors. There was no difference in the presence of symptomatic intracerebral hemorrhage between the two groups (10.13 vs. 12.68%, = 0.573). Despite their older age, AF patients achieved similar outcomes as non-AF patients with anterior circulation occlusion treated with endovascular therapy.

The prevalence of acute ischemic stroke (AIS) is increasing among people of working age, posing socioeconomic and healthcare challenges. Inability to return to work can have significant negative consequences and contribute to the economic burden of stroke. Endovascular treatment (EVT) has been established as the standard of care for large vessel occlusion AIS patients. In this study, we aimed to identify factors predicting favorable outcome among working age AIS patients undergoing EVT. We analyzed data from 309 patients from five comprehensive stroke centers between 2019 and 2023. All patients were working age (18<59) with symptoms onset of within 24 hours. Modified thrombolysis in cerebral infarction (mTICI) score of 2b-3 was considered as successful recanalization. We used 3-months mRS post-EVT to evaluate the outcome; mRS of 0-2 was defined as favorable outcome, whereas mRS of 3-6 was considered unfavorable outcome. The unfavorable outcome group consisted of 150 patients, and 159 patients were in the favorable outcome group. More people in the unfavorable outcome group had diabetes (29.33% vs 15.72%, p=0.004) and hypertension (61.33% vs 40.88, p<0.001). A multivariable regression analysis demonstrated that several factors, including successful recanalization (odds ratio (OR) 5.298, 95% confidence interval (CI) 1.735-16.174, p=0.003), pre-EVT NIHSS (OR 0.892, 95% CI 0.852-0.934, p=0.000), baseline Alberta stroke program early CT score (ASPECTS) (OR 1.609, 95% CI 1.274-2.032, p=0.000), hypertension (OR 0.477, 95% CI 0.270-0.845, p=0.011), diabetes mellitus (OR 0.413, 95% CI 0.208-0.820, p=0.011), and symptomatic intracerebral hemorrhage (sICH) (OR 0.045, 95% CI 0.006-0.359, p=0.003) can predict the outcome of patients undergoing EVT. Favorable outcome of working age patients with AIS undergoing EVT can be predicted using multiple factors, including hypertension, diabetes mellitus, successful recanalization, pre-EVT NIHSS, baseline ASPECTS, and sICH.

Early neurological deterioration after endovascular thrombectomy (EVT) is associated with poor prognosis. National Institutes of Health Stroke Scale (NIHSS) score measured at 24 h after EVT may be a better outcome predictor than other methods that focus on changes in NIHSS. Nevertheless, clinical fluctuations in ischemic stroke patients during the immediate phase after symptoms onset are well recognized. Therefore, a delayed NIHSS evaluation may improve prognostic accuracy. We evaluate the 7-day NIHSS in predicting long-term patient outcomes after EVT.This was a multi-center retrospective cohort study of 300 consecutive ischemic stroke patients with large vessel occlusion who underwent EVT at three-stroke centers in China from August 2018 to March 2022. NIHSS was recorded on admission, pre-EVT, 24 h, and 7 days after EVT.A total of 236 eligible patients were subdivided into two groups: 7-day NIHSS ≤6 and NIHSS >6 post-EVT. 88.29% achieved a favorable outcome (modified Rankin Scale 0–2) in the NIHSS ≤6 group compared to 15.20% in the NIHSS >6 group at 90 days, and an improved favorable outcome in the former group was observed after adjusting for potential confounding factors (adjusted odds ratio 39.7, 95% confidence interval, 17.5–89.7, p < 0.001).The 7-day NIHSS score may be a reliable predictor of 90-day stroke patient outcome after EVT.

IntroductionEndovascular treatment (EVT) is an effective treatment for patients with acute ischemic stroke (AIS); however, it remains to be determined if treatment with intravenous thrombolysis (IVT) prior to EVT confers any benefit in octogenarians and older. This study aimed to address if bridging tPA has improved functional outcomes or complications in patients 80 years and older.MethodsThis multicentre retrospective cohort study included patients 80 years old and above who underwent endovascular therapy for large vessel occlusion acute ischaemic stroke in 10 compressive stroke centres across China and Singapore between 2018 and 2024. Clinical and procedural factors of patients in Singapore and China were compared using multivariate binary logistic regression. The primary outcome measured was 3-month functional independence defined as modified rankin scale (mRS) 0–2. Secondary outcomes included 3-month independent ambulation as defined as mRS 0–3, 3-month mortality rates and achieving successful recanalization. Data on intracranial haemorrhage was also collected.ResultsBridging IVT was not associated with improvement in 3-month functional independence (24.47% vs. 20.97%; p = 0.505), improvement in 3-month independent ambulation (32.80% vs. 41.49%; p = 0.512), 3-month mortality rates (36.17% vs. 33.33%; p = 0.637) or increased rates of successful recanalisation (89.36% vs. 87.63%; p = 0.672),. Instead, patients who underwent bridging IVT had higher rates of haemorrhage compared to patients who did not undergo bridging IVT even after adjusting for confounding factors (OR = 1.921; 95% CI 1.026–3.596; p = 0.041).ConclusionThe findings of this study suggest that bridging IVT prior to EVT may not improve functional outcomes or mortality rates. However, it appears to be associated with an increase in risk of intracranial haemorrhage.

IntroductionParenchymal haematoma (PH) is a potentially serious complication post endovascular treatment (EVT) and is associated with poor functional outcomes. It is unknown if modifiable factors can improve the outcomes of patients with PH. This study aimed to determine whether successful reperfusion is associated with favourable outcome in patients with ischemic stroke despite this complication.Methods In an international multi-centre study, favourable outcomes (mRS0-2) of patients achieving successful reperfusion (TICI 2b/3) were compared with outcomes of those with unsuccessful reperfusion. Results 346 patients were included in the final analysis. 36 patients had unsuccessful reperfusion (10.4%) while 310 had successful reperfusion (89.6%). Amongst patients with PH post-EVT, successful reperfusion conferred better 3-month favourable outcomes (20.32% vs 5.56%; p=0.032) and lower mortality rates (40.32% vs 72.22%; p <0.001) compared with patients who had unsuccessful reperfusion. Conclusion Successful reperfusion remains a strong predictor of favourable outcome and reduced mortality in ischemic stroke patients with parenchymal haematoma post endovascular treatment.