Analysis of Risk Factors for Futile Recanalization Following Mechanical Thrombectomy in Acute Ischemic Stroke

Background and Purpose Mechanical thrombectomy (MT), while effectively enhancing recanalization in acute ischemic stroke (AIS), still results in futile recanalization (FR) — absent functional recovery despite reperfusion success — in approximately 50% of cases. This study investigates FR-associated risk factors, refines patient selection and thrombectomy procedures, and explores targeted therapies addressing FR pathophysiology, ultimately aiming to reduce FR incidence and improve outcomes in MT-treated AIS patients. Methods This retrospective cohort study included 597 AIS patients with anterior circulation LVO undergoing MT (2020–2023). Patients were stratified by 90-day mRS into ER (mRS < 3, n = 291) and FR (mRS ≥ 3, n = 306) groups. Demographic, clinical, and intraoperative imaging data were analyzed. Univariate and multivariate logistic regression (P < 0.1 threshold) identified independent FR risk factors. Results Multivariate analysis identified coronary artery disease(OR = 2.209, 95% CI 1.272–3.835), higher preoperative NIHSS scores(OR = 1.067, 95% CI 1.040–1.094), symptomatic intracranial hemorrhage(OR = 12.721, 95% CI 3.358–48.185), Malignant cerebral edema (OR = 3.350, 95% CI 1.833–6.121), ASITN/SIR collateral grade (OR = 1.013, 95% CI 1.001–1.026), and elevated admission SBP (1.013[1.001–1.026]) as independent predictors of futile recanalization. The nomogram prediction model based on the above factors shows that the area under the subject operating characteristic curve (AUC) is 0.829, which shows a good prediction effect. Conclusion This study identified key determinants of futile recanalization (FR) after mechanical thrombectomy (MT) in acute large vessel occlusion stroke. The validated nomogram demonstrated robust predictive utility for post-MT FR, offering translational insights and actionable therapeutic targets to optimize endovascular outcomes.