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Original research
Predictors of futile recanalization in patients undergoing endovascular treatment in the DIRECT-MT trial
  1. Tengfei Zhou1,2,
  2. Tingyu Yi3,
  3. Tianxiao Li1,2,
  4. Liangfu Zhu1,
  5. Yucheng Li1,
  6. Zhaoshuo Li1,
  7. Meiyun Wang4,
  8. Qiang Li1,
  9. Yingkun He1,
  10. Pengfei Yang5,
  11. Yongwei Zhang5,
  12. Zifu Li5,
  13. Yongxin Zhang5,
  14. Xiaofei Ye6,
  15. Wenhuo Chen3,
  16. Shouchun Wang7,
  17. Jianmin Liu5
  18. DIRECT-MT Registry Investigators
  1. 1 Department of Cerebrovascular Disease, Henan Provincial People's Hospital, Zhengzhou, Henan, China
  2. 2 Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Zhengzhou, China
  3. 3 Department of Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
  4. 4 Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
  5. 5 Department of Neurosurgery, Naval Medical University Changhai Hospital, Shanghai, China
  6. 6 Department of Statistics, Naval Medical University, Shanghai, China
  7. 7 Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China
  1. Correspondence to Dr Tianxiao Li, Department of Cerebrovascular disease, Henan Provincial People's Hospital, Zhengzhou, Henan, China; litianxiao6666{at}


Background Futile recanalization—when patients have a successful recanalization but fail to achieve a satisfactory functional outcome— is a common phenomenon of endovascular treatment of acute ischemic stroke (AIS). The present study aimed to identify the predictors of futile recanalization in AIS patients who received endovascular treatment.

Methods This is a post-hoc analysis of the DIRECT-MT trial. Demographics, clinical characteristics, acute stroke workflow interval times, biochemical parameters, and imaging characteristics were compared between futile and meaningful recanalization groups. Multivariate analysis was performed to identify the predictors of futile recanalization.

Results Futile recanalization was observed in 277 patients. In multivariable logistic regression analysis, older age (p<0.001), higher baseline systolic blood pressure (SBP) (p=0.032), incomplete reperfusion defined by extended Thrombolysis In Cerebral Infarction (eTICI) grades (p=0.020), and larger final infarct volume (FIV) (p<0.001) were independent predictors of futile recanalization.

Conclusions Old age, high baseline SBP, incomplete reperfusion defined by eTICI, and large FIV were independent predictors of futile recanalization after endovascular therapy for AIS.

  • stroke
  • thrombectomy
  • thrombolysis

Data availability statement

Data are available in a public, open access repository. All free text entered below will be published.

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Data availability statement

Data are available in a public, open access repository. All free text entered below will be published.

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  • Contributors TFZ, TXL, QL, ZSL, LFZ, YCL, YKH and MYW designed the study, PFY, YXZ, ZFL, JML, YWZ,TYY, WHC and SCW conducted the trial and collected information, TFZ drafted the manuscript, all authors critically reviewed the manuscript and approved the final version.

  • Funding Supported by a grant (GN-2017R0001) from the Stroke Prevention Project of the National Health Commission of the People’s Republic of China and by the Wu Jieping Medical Foundation; the National Key R&D Program of China (2017YFE0103600), National Natural Science Foundation of China (81720108021,), Scientific and Technological Research Project of Henan Province (182102310162).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.