ABSTRACT NUMBER: ESOC2026A989 RISK FACTORS FOR FUTILE RECANALIZATION AFTER ENDOVASCULAR TREATMENT IN LARGE-CORE ISCHEMIC STROKE: INSIGHTS FROM REAL-WORLD CLINICAL PRACTICE

Abstract Background and aims Endovascular treatment (EVT) is the standard of care for acute ischemic stroke (AIS) with large vessel occlusion (LVO), including patients with large-core infarcts. However, futile recanalization (FR)—successful angiographic reperfusion without functional recovery—remains a major challenge. This study aimed to identify risk factors for FR in patients with large-core AIS undergoing EVT. Methods We conducted a multicenter, retrospective analysis of patients with large ischemic strokes (ASPECTS ≤5) due to anterior circulation LVO within 24 hours (July 2023–September 2024). FR was defined as modified Rankin Scale (mRS) ≥3 at 90 days despite achieving modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. Baseline demographics, imaging, and procedural variables were collected. Multivariate logistic regression analyses identified independent predictors. Results Of 363 patients, 332 achieved successful recanalization, with an FR rate of 56% (186/332). Compared with non-FR, FR patients were older (67.3 vs 58.5, p<0.001), had higher NIHSS score (19 vs 16, p<0.001), and more diabetes (p=0.001) and atrial fibrillation (p=0.002). Median puncture-to-reperfusion times were longer in FR patients but not independently predictive. Multivariate analysis showed age (OR 1.063; 95% CI 1.038–1.089; p<0.001), NIHSS score (OR 1.056; p=0.029), diabetes (OR 2.28; p=0.01), tandem occlusion (OR 2.056; p=0.03), and symptomatic intracranial hemorrhage (OR 27.55; p<0.001) were independent associated with FR, while prior IV tPA was protective (OR 0.46; p=0.015). Conclusions Advanced age, higher initial NIHSS, diabetes, tandem occlusion, and post-procedural symptomatic intracranial hemorrhage increase FR risk, whereas intravenous thrombolysis may reduce it. These findings highlight the need for individualized treatment strategies for this high-risk population. Conflict of interest Hang Tran: nothing to disclose, Trung Quoc Nguyen: nothing to disclose, Khang Nguyen: nothing to disclose, Thien Le: nothing to disclose, Dung Bach: nothing to disclose, Lanh Nguyen: nothing to disclose, Thang Huy Nguyen: nothing to disclose