Advances in Futile Reperfusion following Endovascular Treatment in Acute Ischemic Stroke due to Large Vessel Occlusion

Abstract

<b><i>Background:</i></b> Futile reperfusion (FR) is becoming an urgent issue for acute ischemic stroke patients who underwent endovascular treatment (EVT). Although the recanalization rate has improved after EVT, it is far from translating to increased tissue reperfusion and functional independence. <b><i>Summary:</i></b> Many underlying mechanisms including the “no-reflow” phenomenon, poor collateral flow, venous dysfunction, and inflammation were proposed, but the pathophysiology of FR is still unclear. Clinically, reliable predictors are still yet to be identified, and ongoing trials on shortening the time delay and cytoprotection may provide novel ideas for interventions of FR. <b><i>Key Messages:</i></b> This review will summarize the latest advances in FR and hopefully shed light on potential interventions.

Postoperative fibrinogen‐to‐albumin ratio acting as an indicator of futile recanalization in patients with successful thrombectomy

“…To date, the mechanisms of futile recanalization are poorly understood (Deng et al, 2022). No-reflow phenomenon and inflammatory responses are thought to be important mechanisms (Deng et al, 2022;Wang & Xiong, 2023). The no-reflow phenomenon is currently believed to reflect a compromise of the microvascular system, secondary to the dysfunction of endothelia and luminal clogging by leukocytes and microthrombi (Dalkara & Arsava, 2012;Ng et al, 2022).…”

“…A previous study found that high FAR could predict the occurrence of no-reflow phenomenon in patients with myocardial infarction undergoing primary percutaneous coronary intervention (Zhao et al, 2019). As no-reflow phenomenon and inflammatory response are proposed underlying mechanisms of futile recanalization (Deng et al, 2022;Wang & Xiong, 2023), FAR might also be a potential indicator of futile recanalization in acute ischemic stroke patients. This study aims to evaluate whether postoperative FAR could act as an indicator of futile recanalization in patients with successful thrombectomy.…”

Systemic-inflammatory indices and clinical outcomes in patients with anterior circulation acute ischemic stroke undergoing successful endovascular thrombectomy

“…With the advancements in interventional devices and recanalization techniques, the success rate of EVT now stands at 80%–90 %. However, postoperative reperfusion injury continues to be a prevalent concern leading to early complications [e.g., symptomatic intracranial hemorrhage (sICH)] and neurological deterioration, which can ultimately affect long-term clinical outcomes [ [5] , [6] , [7] ]. Additionally, the invasive nature of EVT may cause vascular wall injury (VWI), which can result in peri-interventional hemorrhagic and ischemic complications, ultimately reducing treatment efficacy and clinical outcomes [ [8] , [9] , [10] ].…”

Asymptomatic parenchymal haemorrhage following endovascular treatment: Impact on functional outcome in patients with acute ischaemic stroke

“…A lesson learned from the first decade of EVT is that successful recanalization is not a synonym of favourable outcome. A great proportion of patients (32.4%–69.6%) showing an angiographically accomplished result at the end of the procedure still present with unfavourable clinical outcome [4]. This has led to the term clinically ineffective reperfusion (CIR).…”