Abstract Number: Esoc2026a888 Predictors of Futile Recanalization in Patients With Acute Ischemic Stroke and Large Infarct: A Secondary Analysis of the Tension Trial

Abstract Background and aims Endovascular thrombectomy (EVT) has been shown to improve outcomes in acute ischemic stroke caused by large-vessel occlusion. However, many patients experience poor functional outcomes despite successful reperfusion, termed “futile recanalization (FR)”. Predictors of FR in patients with large infarcts remain poorly understood. This study aimed to identify predictors of FR among patients with large infarcts in the TENSION trial. Methods This secondary analysis included patients from the TENSION randomized controlled trial who achieved successful reperfusion, defined as Thrombolysis in Cerebral Infarction (TICI) ≥2b. Poor outcome was defined as modified Rankin Scale (mRS) 3 at 12 months. Baseline demographic, clinical and periprocedural variables were compared between outcome groups. Univariable and multivariable logistic regression were used to identify independent predictors. Results Of 128 patients undergoing EVT, 110 (85.9%) achieved successful reperfusion. Of these, 68 (62.4%) patients experienced poor outcomes at 12 months. Patients with poor outcomes were older, had higher baseline NIHSS, more ICA occlusions and less frequently received intravenous thrombolysis. Patients with FR had larger 24-hour infarct volumes (253 vs 122 mL, p0.001). In multivariable analysis, older age (OR 1.15, 95% CI 1.05-1.30, p=0.006) and 24-hour infarct volume (OR 1.15 per 10 mL, 95% CI 1.04–1.33, p=0.024) were independently associated with poor outcome. Conclusions In patients with large infarcts undergoing EVT, older age and larger 24-hour infarct volume were independent predictors of FR. Our findings support the value of infarct volume on early follow-up imaging as an imaging surrogate to identify patients at risk for FR. Conflict of interest MDH reports funding from Nil; grants to the University of Calgary for the TEMPO-2 trial from Boehringer Ingelheim, Biogen, NoNO (ESCAPE-NA1 trial and ESCAPE-NEXT trial), Canadian Institute for Health Research (ESCAPE-NA1 trial and ESCAPE-NEXT trial), Medtronic (HERMES collaboration), Alberta Innovates (QuICR Alberta Stroke Program); that some of the funds were used for the ESCAPE-NA1 trial from Alberta Innovates; consulting fees from Sun Pharma Brainsgate (paid work for adjudication of clinical trial outcomes); US patents 62/086,077 (licensed to Circle NVI) and 10,916,346 (licensed to Circle NVI); private stock ownership from Circle and PUreWeb; participation as data and safety monitoring committee chair of the RACECAT trial (end 2020), the Oncovir Hiltonel trial (ongoing), and the DUMAS trial (ongoing); participation as a data and safety monitoring committee member of the ARTESIA trial (ongoing), and the BRAIN-AF trial (ongoing); and is president of the Canadian Neurological Sciences Federation (not for profit) and a Board member of the Canadian Stroke Consortium (not for profit). JF reports funding from the European Commission; personal consulting fees from Acandis, Cerenovus, Medtronic, Microvention, Phenox, Stryker, and Roche; consulting at Philips (no payments); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Penumbra and Tonbridge; support for attending meetings or travel from Medtronic and Penumbra; stock or stock options from Tegus Medical, Eppdata, and Vastrax; and participation in a Data Safety Monitoring Board or Advisory Board at Phenox (personal fees) and Stryker (personal fees) and is a past president of ESMINT. GT reports funding from the European Commission (EUHorizon 2020 research and innovation programme, 754640; payments to the institution); personal consulting fees from Acandis, AstraZeneca, Bayer, Boehringer Ingelheim, and Stryker; personal payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Acandis, Alexion, Marin, Bayer, Boehringer Ingelheim, BristolMyersSquibb/Pfizer, Daiichi Sankyo, and Stryker; participation as DSMB member for the TEA Stroke Trial (no payments) and ReSCInD trial (no payments); work as a speaker of the Commission for Cerebrovascular Diseases of the German Society of Neurology (DGN; no payments); and membership of the Board of Directors of the European Stroke Organisation (ESO; no payments). DFV reports research grants from MicroVention; consulting fees from Medtronic; and paid lectures from Cerenovus and Johnson consulting fees from Siemens; and support for attending meetings or travel from Europa Group. MB reports funding from EU Horizon 2020 and Deutsche Forschungsgemeinschaft (payments to the institution); honoraria for lectures from Novartis, Boehringer Ingelheim, and Seagen; and consulting fees from NeuroScios and Boehringer Ingelheim and is an editor in chief of Clinical Neuroradiology (Springer). OC and PH: Nothing to disclose.