ABSTRACT NUMBER: ESOC2026A2414 PREDICTORS OF FUTILE RECANALIZATION IN ACUTE ISCHEMIC STROKE PATIENTS UNDERGOING MECHANICAL THROMBECTOMY IN THE 6–24 HOUR WINDOW BASED ON BASIC IMAGING

Abstract Background and aims Futile recanalization remains frequent after successful mechanical thrombectomy (mTICI 2b–3). Evidence from Viet Nam is limited, particularly for predictors derived from basic imaging. We aimed to identify clinical and basic imaging predictors of futile recanalization in patients treated in the 6–24 hour window at the Bach Mai Stroke Center (BMSC). Methods We conducted a prospective, non-randomized, single-center observational cohort study at BMSC. Consecutive patients undergoing mechanical thrombectomy in the 6–24 hour window between January and September 2025 were enrolled. The primary outcome was futile recanalization at 90 days, defined as mRS 3–6 despite successful reperfusion (mTICI 2b–3). Results Overall, 64 patients were included; 56 (87.5%) achieved successful reperfusion (mTICI 2b–3) and comprised the analytic cohort. Among these, 23 were women (41.1%) and the median age was 70 years (IQR 63–75). Median baseline NIHSS and ASPECTS were 14 (IQR 12–15) and 7 (IQR 6–7), respectively. At 90 days, futile recanalization occurred in 32/56 patients (57.1%). In multivariable logistic regression, hypertension (OR 4.18; 95% CI 1.24–14.11; p=0.021) and poor collaterals (0–1 points) (OR 6.90; 95% CI 1.31–36.46; p=0.023) were independently associated with futile recanalization. Conclusions Futile recanalization after successful extended-window thrombectomy was common and was independently associated with hypertension and poor collateral status (0–1 points). Conflict of interest Dr. Minh Anh: Nothing to disclose