The Association Between Venous Sinus Opacification Time and Futile Recanalization in Patients with Large Vessel Occlusion Acute Ischemic Stroke

INTRODUCTION: This study aimed to determine whether venous sinus opacification time on final digital subtraction angiography (DSA), a proposed marker of microcirculatory perfusion, predicts futile recanalization after successful endovascular thrombectomy (EVT) in patients who experienced anterior circulation large vessel occlusion (LVO) stroke. METHODS: We retrospectively enrolled consecutive patients with anterior circulation LVO who underwent EVT and achieved successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2c-3). Venous sinus opacification time was defined as the interval from first contrast opacification of the internal carotid artery to first venous sinus opacification on the final angiographic run. Futile recanalization was defined as poor functional outcome at 3 months (modified Rankin Scale [mRS] > 3). Multivariable logistic regression, restricted cubic spline, receiver operating characteristic (ROC), and subgroup interaction analyses were performed. Incremental prognostic value was assessed by comparing models with and without venous sinus opacification time. RESULT: A total of 205 patients were included, and 102 (49.8%) had futile recanalization. Venous sinus opacification time was independently associated with futile recanalization (odds ratio per 1-s increase 2.148; 95% confidence interval 1.543-2.991; p < 0.001). Adding venous sinus opacification time improved discrimination (AUC 0.700 vs. 0.782; DeLong p = 0.003) and reduced the Brier score (0.22 to 0.19). The association was approximately linear (p for nonlinearity = 0.143). A cutoff of 5.7 s showed high specificity (0.893) and modest sensitivity (0.392). No significant interactions were observed across prespecified subgroups. CONCLUSION: Venous sinus opacification time on final DSA independently predicts futile recanalization after EVT and provides incremental prognostic value beyond established clinical predictors.