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Original research
Futile reperfusion of endovascular treatment for acute anterior circulation large vessel occlusion in the ANGEL-ACT registry
  1. XinGuang Yang1,2,
  2. Dapeng Sun1,
  3. Xiaochuan Huo1,
  4. Raynald Raynald1,
  5. BaiXue Jia1,
  6. Xu Tong1,
  7. Anxin Wang3,
  8. Ning Ma1,
  9. Feng Gao1,
  10. Dapeng Mo1,
  11. Zhongrong Miao1
  12. on behalf of the ANGEL-ACT study group
    1. 1 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    2. 2 Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
    3. 3 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    1. Correspondence to Dr Zhongrong Miao, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; zhongrongm{at}; Dr Xiaochuan Huo, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Bejing 100070, People's Republic of China; huoxiaochuan{at}


    Background Some patients with large vessel occlusion (LVO) still cannot achieve functional independence despite successful reperfusion after endovascular treatment (EVT), named futile reperfusion. We aimed to explore the incidence and predictors of futile reperfusion of EVT for anterior circulation LVO in the Chinese population based on a nationwide prospective multicenter registry.

    Methods We selected patients from the ANGEL-ACT (Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischemic Stroke) registry. Successful reperfusion was defined as modified Treatment In Cerebral Ischemia (mTICI) 2b-3 after EVT, and functional independence was defined as 90-day modified Rankin Scale (mRS) 0–2. A multivariable regression model was performed to identify the independent predictors of futile reperfusion in anterior circulation LVO patients.

    Results A total of 1158 anterior circulation LVO patients were included in our study. 600 of the 1158 patients (51.8%) suffered futile reperfusion. Age ≥69 (adjusted OR (aOR) 1.69, 95% CI 1.21 to 2.35, P=0.002), baseline National Institutes of Health Stroke Scale (NIHSS) ≥14 (aOR 2.36, 95% CI 1.71 to 3.27, P<0.001), baseline serum glucose ≥6.5 mmol/L (aOR 1.73, 95% CI 1.27 to 2.36, P=0.001), drip and ship (aOR 1.56, 95% CI 1.11 to 2.18, P=0.011), and general anesthesia (aOR 2.28, 95% CI 1.66 to 3.14, P<0.001) were associated with a high risk of futile reperfusion in the anterior LVO patients after EVT, whereas baseline Alberta Stroke Program Early CT Score (ASPECTS) ≥8 (aOR 0.65, 95% CI 0.47 to 0.91, P=0.011) and complete reperfusion (aOR 0.62, 95% CI 0.43 to 0.89, P=0.010) were associated with a low risk of futile reperfusion in the anterior LVO patients after EVT.

    Conclusions In the ANGEL-ACT registry, 51.8% of anterior circulation LVO patients suffered futile reperfusion after EVT. Age ≥69 years, baseline NIHSS ≥14, baseline serum glucose ≥6.5 mmol/L, drip and ship, general anesthesia, baseline ASPECTS <8, and incomplete reperfusion were the independent predictors of futile reperfusion.

    • Stroke
    • Thrombectomy

    Data availability statement

    Data are available upon reasonable request.

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    • XY and DS contributed equally.

    • Collaborators List of ANGEL-ACT study group: Beijing Tiantan Hospital, Beijing, China: Zhongrong Miao, MD; Langfang Changzheng Hospital, Hebei, China: Liqiang Gui, MD; Liaocheng Third People’s Hospital, Shandong, China: Cunfeng Song, MD; The First People’s Hospital of Changzhou, Jiangsu, China: Ya Peng, MD; The Second Affiliated Hospital of Nanjing Medical University, Jiangsu, China: Jin Wu, MD; Fengrun District People’s Hospital of Tangshan City, Hebei, China: Shijun Zhao, MD; SiPing Central People’s Hospital, Jilin, China: Junfeng Zhao, MD; Yijishan Hospital of Wannan Medical College, Anhui, China: Zhiming Zhou, MD; The 2nd Affiliated Hospital of Harbin Medical University, Heilongjiang, China: Yongli Li, MD; The Central Hospital of Wuhan, Hubei, China: Ping Jing, MD; The First Hospital of Shijiazhuang, Hebei, China: Lei Yang, MD; Shenzhen Hospital of Southern Medical University, Guangdong, China: Yajie Liu, MD; The People’s Hospital of Longhua, Guangdong, China: Qingshi Zhao, MD; Jingjiang People’s Hospital, Jiangsu, China: Yan Liu, MD; The Third People’s Hospital of Hubei Province, Hubei, China: Xiaoxiang Peng, MD; The Second Affiliated Hospital of Guangzhou Medical University, Guangdong, China: Qingchun Gao, MD; Tianjin TEDA Hospital, Tianjin, China: Zaiyu Guo, MD; Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China: Wenhuo Chen, MD; Taiyuan Central Hospital, Shanxi, China: Weirong Li, MD; The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China: Xiaojiang Cheng, MD; Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China: Yun Xu, MD; The First People’s Hospital of Wenling, Zhejiang, China: Yongqiang Zhang, MD; The Second Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China: Guilian Zhang, MD; The First People’s Hospital of Yulin, Guangxi, China: Yijiu Lu, MD; Zhenjiang First People’s Hospital, Jiangsu, China: Xinyu Lu, MD; Qitaihe Coal General Hospital Heilongjiang, China: Dengxiang Wang, MD; People’s Hospital of Tangshan City, Hebei, China: Yan Wang, MD; Affiliated Hospital of Guilin Medical University, Guangxi, China: Hao Li, MD; The Affiliated Hospital of Guizhou Medical University, Guizhou Province, China: Yang Hua, MD; The Affiliated Hospital of Xuzhou Medical University, Jiangsu, China: Deqin Geng, MD; Qingdao Central Hospital, ShanDong, China: Haicheng Yuan, MD; The Fourth People’s Hospital of Langfang City, Hebei, China: Hongwei Wang, MD; Beijing Daxing hospital, Beijing, China: Haihua Yang, MD; Weifang People’s Hospital,ShanDong, China: Zengwu Wang, MD; Luoyang General Hospital Affiliated to Zhengzhou University, Henan, China: Liping Wei, MD; Dongguan Kanghua Hospital, Guangdong, China: Xuancong Liufu, MD; Shunde Hospital of Southern Medical University, Guangdong, China: Xiangqun Shi, MD; Handan Central Hospital, Hebei, China: Juntao Li, MD; The 981 hospital of the Chinese People’s Liberation Army, Hebei, China: Wenwu Yang, MD; Linfen people’s Hospital, Shanxi, China: Wenji Jing, MD; Anshun people’s Hospital of Guizhou, China: Xiang Yong, MD; Changle People’s Hospital, Shandong, China: Leyuan Wang, MD; The Second People’s Hospital of Dongying, Shandong, China: Chunlei Li, MD; Tangshan Gongren hospital, HeBei, China: Yibin Cao, MD; PLA 985th Hospital of the Joint Logistics Support Force, Shanxi, China: Qingfeng Zhu, MD; Gaomi People’s Hospital, ShanDong, China: Peng Zhang, MD; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China: Xiang Luo, MD; Chongqing Sanxia Center Hospital, Chongqing, China: Shengli Chen, MD; Hospital of Traditional Chinese Medicine of Qiannan, Guizhou, China: WenWu Peng, MD; Guangdong Hospital of Chinese Medicine, Guangdong, China: Lixin Wang, MD; People’s hospital of Yangjiang,Guangdong, China: Xue Wen, MD; The Third Affiliated Hospital of CQMU, Chongqing, China: Shugui Shi, MD; General Hospital of The Yangtze River Shipping, Hubei, China: Wanming Wang, MD; First People’s Hospital of Bijie City,Guizhou, China: Wang Bo, MD; Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group, Jiangsu, China: Pu Yuan, MD; Weifang TCM Hospital, Shandong, China: Dong Wang, MD; The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China: Haitao Guan, MD; Karamay Central hospital, Xinjiang, China: Wenbao Liang, MD; The third people’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China: Daliang Ma, MD; Wulanchabu City Central Hospital, Inner Mongolia, China: Long Chen, MD; Hospital of Xinjiang Production & Construction Corps, Xinjiang, China: Yan Xiao, MD; Jiaozuo Second people’s hospital, Henan, China: Xiangdong Xie, MD; 904th Hospital of Joint Logistic Support Force of PLA, Jiangsu, China: Zhonghua Shi, MD; Ganzhou People’s Hospital, Jiangxi, China: Xiangjun Zeng, MD; 967 Hospital of the Joint Logistics Support Force of PLA, Liaoning, China: Fanfan Su, MD; The Affiliated Hospital of Northwest University Xi’an No.3 Hospital, Shaanxi, China: MingZe Chang, MD; The Second Hospital of Liao Cheng, Shandong, China: Jijun Yin, MD; Jilin Province People’s Hospital, Jilin, China: Hongxia Sun, MD; People’s Hospital of Huanghua City, Hebei, China: Chong Li, MD; Shanghai Forth People’s Hospital, Shanghai, China: Yong Bi, MD; Wanbei Coal-electricity Group Gneral Hospital, Anhui, China: Gang Xie, MD; Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China: Yuwu Zhao, MD; Binzhou Medical University Hospital, Shandong, China: Chao Wang, MD; The 988 hospital of the people’s liberation army, Henan, China: Peng Zhang, MD; Linyi People’s Hospital, Shandong, China: Xianjun Wang, MD; Yingkou City Central Hospital, Liaoning, China: Dongqun Li, MD; Yantaishan Hospital, Shandong, China: Hui Liang, MD; Mianyang Central hospital, Sichuan, China: Zhonglun Chen, MD; Chengdu Fifth People’s Hospital, Sichuan, China: Yan Wang, MD; Hengshui Fifth Hospital of Heng shui City, HeBei, China: Yu Xin, Wang, MD; Second Hospital of Dalian Medical University, Liaoning, China: Lin Yin, MD; Boai Hospital of Zhongshan, Guangdong, China: HongKai Qiu, MD; The First People’s Hospital of Yibin, Sichuan, China: Jun Wei, MD; Shanxi provincial people’s hospital, Shanxi, China: Yaxuan Sun, MD; Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China: Xiaoya Feng, MD; Chuxiong State People’s Hospital, Chuxiong, Yunnan, China: Weihua Wu, MD; The Fourth Affiliated Hospital of China Medical University, Liaoning, China: Lianbo Gao, MD; Taihe Hospital, Shiyan, Hubei, China: Zhibing Ai, MD; Qingdao Municipal Hospital,Shandong, China: Tan Lan, MD; The First People’s Hospital of Yunnan Province, Yunnan, China: Li Ding, MD; The NO.2 People’s Hospital of Lanzhou. Gansu, China: Qilong Liang, MD; Taizhou First People’s Hospital, Zhejiang, China: Zhimin Wang, MD; Hunan Provincial People’s Hospital, Hunan, China: Jianwen Yang, MD; First People’s Hospital of Changde City, Hunan, China: Ping Xu, MD; Zhejiang Yuyao People’s Hospital, Zhejiang, China: Wei Dong, MD; AideBao Hospital, HeBei, China: Quanle Zheng, MD; The First Hospital of Fangshan District, Beijing, China: Zhenyun Zhu, MD; Tianjin Xiqing Hospital, Tianjin, China: Liyue Zhao, MD; People’s Hospital of Zunhua, Hebei, China: Qingbo Meng, MD; Xingtai Third Hospital, Hebei, China: Yuqing Wei, MD; Qingyuan People’s Hospital, Guangdong, China: Xianglin Chen, MD; Fengcheng City Central Hospital,Liaoning, China: Wei Wang, MD; People’s Hospital of Hejian City, Hebei, China: Dong Sun, MD; Hangzhou Third People’s Hospital, Zhejiang, China: Yongxing Yan, MD; Xiangtan Central Hospital, Hunan, China: Guangxiong Yuan, MD; People’s Hospital of Nanpi Country, Hebei, China: Yadong Yang, MD; Liuzhou Railway Central Hospital, Guangxi, China: Jianfeng Zhou, MD; Maoming People’s Hospital, Guangdong, China: Zhi Yang, MD; Tongde Hospital of Zhejiang Province, Zhejiang, China: Zhenzhong Zhang, MD; The First Affiliated Hospital of Jinzhou Medical University, Liaoning, China: Ning Guan, MD; Xishan coal electricity group worker general hospital, Shaanxi, China: Huihong Wang, MD.

    • Contributors ZM, DS, and XY were involved in the study conception. Statistical analysis was done by AW. The article was drafted by DS and XY. All authors reviewed and approved the final article. Guarantors: ZM and XH.

    • Funding The ANGEL-ACT registry was funded by the National Key Research and Development Program of China, grant number 2016YFC1301500.

    • Competing interests None declared.

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

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