Neuroimaging Predictors of Futile Recanalization in Posterior Circulation Stroke: A Systematic Review and Meta-Analysis.

Authors

Sana Mozaffari, Faryar Koolinia, Negin Safari Dehnavi, Yasaman Mohammadi, Iman Kiani, Hanieh Mahmoudzadeh, Saeed Mohammadzadeh, Dhairya A Lakhani, Hamza A Salim, Yasmin N Aziz, Aakanksha Sriwastwa, Shyam Majmundar, Adam A Dmytriw, Adrien Guenego, Risheng Xu, Hanzhang Lu, Gregory W Albers, David Liebeskind, Kambiz Nael, Jeremy J Heit, Tobias D Faizy, Arindam R Chatterjee, Elizabeth A Fracica, Ferdinand Hui, Vaibhav S Vagal, Vivek S Yedavalli

Published in

AJNR. American journal of neuroradiology. Aug 11, 2026. Epub Aug 11, 2026.

Abstract

This systematic review and meta-analysis aimed to synthesize evidence on baseline and procedural neuroimaging markers associated with futile recanalization in posterior circulation stroke.
A systematic search was conducted across PubMed, Scopus, Web of Science, and Embase from inception through April 2025.
Studies evaluating neuroimaging predictors of futile recanalization in patients with posterior circulation stroke who achieved successful recanalization (mTICI ≥2b) after endovascular treatment were included.
Risk of bias was assessed using PROBAST. Random-effects meta-analysis was performed for imaging parameters reported in two or more studies. Heterogeneity was assessed using I² statistics, and leave-one-out sensitivity analyses were conducted.
Twelve studies comprising 3,521 patients met the inclusion criteria. Meta-analysis of five studies demonstrated that higher PC-ASPECTS scores were significantly associated with reduced odds of futile recanalization (pooled OR = 0.72, 95% CI: 0.60-0.86; I² = 74.8%). The BATMAN collateral score showed a non-significant general direction toward lower futile recanalization with higher scores (OR = 0.81; 95% CI: 0.57-1.14; I² = 51.8%). Additional imaging predictors identified across studies included PMT score, PC-CS, PComA patency, CBF <35% volume, and cerebral circulation time. Perfusion metrics such as hypoperfusion intensity ratio and core volume did not independently predict futile recanalization.
The current study has several limitations. A small number of included studies (mostly retrospective with limited sample sizes), high heterogeneity (I² = 74.8% for PC-ASPECTS), varying definitions of functional outcome, differing covariates in multivariable models with possible residual confounding, and wide variation in study size/design. Furthermore, we were unable to perform reliable formal subgroup analyses, and publication-bias assessments due to only five eligible studies for PC-ASPECTS and two for BATMAN, necessitating reliance on qualitative assessment and leave-one-out sensitivity analyses while leaving publication bias and small-study effects unexcluded.
PC-ASPECTS is a robust imaging predictor of futile recanalization in posterior circulation stroke. Location-based and collateral-based imaging parameters demonstrate greater prognostic value than volumetric thresholds in this territory. Integration of multiple imaging parameters into composite scores may enhance predictive accuracy and guide patient selection.

PMID:
42580864
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.