
中国卒中杂志 ›› 2026, Vol. 21 ›› Issue (3): 378-386.DOI: 10.3969/j.issn.1673-5765.2026.03.013
• 综述 • 上一篇
张自立,赵颖,孟珩,徐安定
收稿日期:2025-08-11
修回日期:2026-03-15
接受日期:2026-03-18
出版日期:2026-03-20
发布日期:2026-03-20
通讯作者:
徐安定 tlil@jun.edu.cn
ZHANG Zili, ZHAO Ying, MENG Heng, XU Anding
Received:2025-08-11
Revised:2026-03-15
Accepted:2026-03-18
Online:2026-03-20
Published:2026-03-20
Contact:
XU Anding, E-mail: tlil@jun.edu.cn
摘要: 血管内治疗是大血管闭塞性缺血性卒中患者再灌注治疗的主要方法,然而,越来越多的研究表明,即使成功开通闭塞血管,仍有部分患者存在不良功能预后,即无效再通。早期预测无效再通的发生风险,是制订个体化治疗方案、改善患者临床预后的重要环节。本综述对急性缺血性卒中血管内治疗后无效再通的预测研究进行综合梳理,以期为临床医师早期识别无效再通高风险患者、制订合理的临床治疗决策提供新思路。
中图分类号:
张自立, 赵颖, 孟珩, 徐安定. 急性缺血性卒中血管内治疗后无效再通预测研究进展[J]. 中国卒中杂志, 2026, 21(3): 378-386.
ZHANG Zili, ZHAO Ying, MENG Heng, XU Anding. Research Progress on Predicting Futile Recanalization following Endovascular Treatment in Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2026, 21(3): 378-386.
| [1] MA Q F,LI R,WANG L J,et al. Temporal trend and attributable risk factors of stroke burden in China,1990-2019:an analysis for the global burden of disease study 2019[J/OL]. Lancet Public Health,2021,6(12):e897-e906[2026-03-14]. https://doi.org/10.1016/s2468-2667(21)00228-0. [2] 王拥军,李子孝,谷鸿秋,等. 中国卒中报告2020(中文版)(1)[J]. 中国卒中杂志,2022,17(5):433-447. WANG Y J,LI Z X,GU H Q,et al. China stroke statistics 2020(1)[J]. Chin J Stroke,2022,17(5):433-447. [3] HILKENS N A,CASOLLA B,LEUNG T W,et al. Stroke[J/OL]. Lancet,2024,403(10446):2820-2836[2026-03-14]. https://doi.org/10.1016/S0140-6736(24)00642-1. [4] BERKHEMER O A,FRANSEN P S,BEUMER D,et al. A randomized trial of intraarterial treatment for acute ischemic stroke[J]. N Engl J Med,2015,372(1):11-20. [5] GOYAL M,DEMCHUK A M,MENON B K,et al. Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med,2015,372(11):1019-1030. [6] SAVER J L,GOYAL M,BONAFE A,et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke[J]. N Engl J Med,2015,372(24):2285-2295. [7] JOVIN T G,CHAMORRO A,COBO E,et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke[J]. N Engl J Med,2015,372(24):2296-2306. [8] CAMPBELL B C V,MITCHELL P J,KLEINIG T J,et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Engl J Med,2015,372(11):1009-1018. [9] BRACARD S,DUCROCQ X,MAS J L,et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke(THRACE):a randomised controlled trial[J]. Lancet Neurol,2016,15(11):1138-1147. [10] SAVER J L,GOYAL M,VAN DER LUGT A,et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke:a meta-analysis[J]. JAMA,2016,316(12):1279-1288. [11] ALBERS G W,MARKS M P,KEMP S,et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging[J]. N Engl J Med,2018,378(8):708-718. [12] NOGUEIRA R G,JADHAV A P,HAUSSEN D C,et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J]. N Engl J Med,2018,378(1):11-21. [13] HUSSEIN H M,GEORGIADIS A L,VAZQUEZ G,et al. Occurrence and predictors of futile recanalization following endovascular treatment among patients with acute ischemic stroke:a multicenter study[J]. AJNR Am J Neuroradiol,2010,31(3):454-458. [14] TOMSICK T,BRODERICK J,CARROZELLA J,et al. Revascularization results in the interventional management of stroke Ⅱ trial[J]. AJNR Am J Neuroradiol,2008,29(3):582-587. [15] HUSSEIN H M,SALEEM M A,QURESHI A I. Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial[J]. Neuroradiology,2018,60(5):557-563. [16] ZAIDAT O O,YOO A J,KHATRI P,et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke:a consensus statement[J]. Stroke,2013,44(9):2650-2663. [17] GOYAL M,MENON B K,VAN ZWAM W H,et al. Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J]. Lancet,2016,387(10029):1723-1731. [18] DENG G,XIAO J,YU H H,et al. Predictors of futile recanalization after endovascular treatment in acute ischemic stroke:a meta-analysis[J]. J Neurointerv Surg,2022,14(9):881-885. [19] ZHANG Y Y,ZHANG L,ZHANG Y W,et al. Endovascular recanalization for acute internal carotid artery terminus occlusion:a subgroup analysis from the DIRECT-MT trial[J]. Neurosurgery,2022,91(4):596-603. [20] YI T Y,HUO X C,LIN X H,et al. Predictors of futile recanalisation in patients with large infarct:a post-hoc analysis of the ANGEL-ASPECT trial[J/OL]. Stroke Vasc Neurol,2025[2026-03-14]. https://doi.org/10.1136/svn-2024-003382. [21] HEITKAMP C,HEITKAMP A,WINKELMEIER L,et al. Predictors of futile recanalization in ischemic stroke patients with low baseline NIHSS[J]. Int J Stroke,2024,19(10):1102-1012. [22] KITANO T,TODO K,YOSHIMURA S,et al. Futile complete recanalization:patients characteristics and its time course[J/OL]. Sci Rep,2020,10(1):4973[2026-03-14]. https://doi.org/10.1038/s41598-020-61748-y. [23] LIU X F,DAI Q L,YE R D,et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion(BEST):an open-label,randomised controlled trial[J]. Lancet Neurol,2020,19(2):115-122. [24] CASETTA I,FAINARDI E,SAIA V,et al. Endovascular thrombectomy for acute ischemic stroke beyond 6 hours from onset:a real-world experience[J]. Stroke,2020,51(7):2051-2057. [25] VAN HORN N,KNIEP H,LEISCHNER H,et al. Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients[J]. J Neurointerv Surg,2021,13(1):14-18. [26] AL-MUFTI F,AMULURU K,ROTH W,et al. Cerebral ischemic reperfusion injury following recanalization of large vessel occlusions[J]. Neurosurgery,2018,82(6):781-789. [27] BERSANO A,GATTI L. Pathophysiology and treatment of stroke:present status and future perspectives[J/OL]. Int J Mol Sci,2023,24(19):14848[2026-03-14]. https://doi.org/10.3390/ijms241914848. [28] HAO J H,FENG Y,XU X,et al. Plasma lipid mediators associate with clinical outcome after successful endovascular thrombectomy in patients with acute ischemic stroke[J/OL]. Front Immunol,2022,13:917974[2026-03-14]. https://doi.org/10.3389/fimmu.2022.917974. [29] ALAHMARI A. Blood-brain barrier overview:structural and functional correlation[J/OL]. Neural Plast,2021,2021:6564585[2026-03-14]. https://doi.org/10.1155/2021/6564585. [30] ZHANG Y,JIANG M W,GAO Y,et al.“No-reflow”phenomenon in acute ischemic stroke[J]. J Cereb Blood Flow Metab,2024,44(1):19-37. [31] NI H,LIU X L,HANG Y,et al. Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows[J/OL]. Front Neurol,2022,13:958236[2026-03-14]. https://doi.org/10.3389/fneur.2022.958236. [32] GRIFFIS J C,METCALF N V,CORBETTA M,et al. Structural disconnections explain brain network dysfunction after stroke[J]. Cell Rep,2019,28(10):2527-2540. [33] SHEN L A,GAN Q Y,YANG Y C,et al. Mitophagy in cerebral ischemia and ischemia/reperfusion injury[J/OL]. Front Aging Neurosci,2021,13:687246[2026-03-14]. https://doi.org/10.3389/fnagi.2021.687246. [34] EL AMKI M,WEGENER S. Improving cerebral blood flow after arterial recanalization:a novel therapeutic strategy in stroke[J/OL]. Int J Mol Sci,2017,18(12):2669[2026-03-14]. https://doi.org/10.3390/ijms18122669. [35] ARBA F,PICCARDI B,PALUMBO V,et al. Blood-brain barrier leakage and hemorrhagic transformation:the reperfusion injury in ischemic stroke(RISK)study[J]. Eur J Neurol,2021,28(9):3147-3154. [36] XU H F,JIA B X,HUO X C,et al. Predictors of futile recanalization after endovascular treatment in patients with acute ischemic stroke in a multicenter registry study[J/OL]. J Stroke Cerebrovasc Dis,2020,29(10):105067[2026-03-14]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105067. [37] PAN H,LIN C C,CHEN L N,et al. Multiple-factor analyses of futile recanalization in acute ischemic stroke patients treated with mechanical thrombectomy[J/OL]. Front Neurol,2021,12:704088[2026-03-14]. https://doi.org/10.3389/fneur.2021.704088. [38] ZHOU T F,YI T Y,LI T X,et al. Predictors of futile recanalization in patients undergoing endovascular treatment in the DIRECT-MT trial[J]. J Neurointerv Surg,2022,14(8):752-755. [39] BAIK S H,JUNG C,KIM B M,et al. Futile recanalization in patients with basilar artery occlusion:assessment of the underlying etiology and the role of perfusion imaging[J]. J Neurointerv Surg,2025,17(8):837-842. [40] 魏娜,刘欣,聂曦明,等. 侧支状态对急性前循环大血管闭塞性脑梗死无效再通的影响[J]. 中国卒中杂志,2023,18(4):450-455. WEI N,LIU X,NIE X M,et al. Effect of collateral status on futile recanalization after endovascular treatment in patients with acute anterior circulation large vessel occlusive cerebral infarction[J]. Chin J Stroke,2023,18(4):450-455. [41] BAEK J H,KIM B M,HEO J H,et al. Number of stent retriever passes associated with futile recanalization in acute stroke[J]. Stroke,2018,49(9):2088-2095. [42] UNIKEN VENEMA S M,POSTMA A A,VAN DEN WIJNGAARD I R,et al. White matter lesions and outcomes after endovascular treatment for acute ischemic stroke:MR CLEAN registry results[J]. Stroke,2021,52(9):2849-2857. [43] HALLEVI H,BARRETO A D,LIEBESKIND D S,et al. Identifying patients at high risk for poor outcome after intra-arterial therapy for acute ischemic stroke[J]. Stroke,2009,40(5):1780-1785. [44] SARRAJ A,ALBRIGHT K,BARRETO A D,et al. Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke[J]. Stroke,2013,44(12):3324-3330. [45] FLINT A C,CULLEN S P,FAIGELES B S,et al. Predicting long-term outcome after endovascular stroke treatment:the totaled health risks in vascular events score[J]. AJNR Am J Neuroradiol,2010,31(7):1192-1196. [46] MATSUKAWA H,CHEN H,ELAWADY S S,et al. Predicting futile recanalization after endovascular thrombectomy for patients with stroke with large cores:the SNAP score[J]. Neurosurgery,2024,96(5):1080-1088. [47] GAN Y W,HE J,GUAN Z A,et al. A pre-intervention six-item scale for predicting futile recanalization after endovascular therapy in patients with acute ischemic stroke with large core infarction[J]. J Neurointerv Surg,2026,18(4):976-982. [48] VENEMA E,ROOZENBEEK B,MULDER M J H L,et al. Prediction of outcome and endovascular treatment benefit:validation and update of the MR PREDICTS decision tool[J]. Stroke,2021,52(9):2764-2772. [49] GONG C,JIANG S Y,HUANG L P,et al. Predicting futile recanalization by cerebral collateral recycle status in patients with endovascular stroke treatment:the CHANOA score[J]. Acad Radiol,2025,32(5):2876-2885. [50] WANG Y,LI T,WU P F,et al. Predicting futile recanalization before mechanical thrombectomy:the added value of CT imaging markers[J]. Neuroradiology,2025,67(11):3265-3274. . [51] LUO Y Q,SUN X,KONG X,et al. A DWI-based radiomics-clinical machine learning model to preoperatively predict the futile recanalization after endovascular treatment of acute basilar artery occlusion patients[J/OL]. Eur J Radiol,2023,161:110731[2026-03-14]. https://doi.org/10.1016/j.ejrad.2023.110731. [52] SUN T,YU H Y,ZHAN C H,et al. Non-contrast CT radiomics-clinical machine learning model for futile recanalization after endovascular treatment in anterior circulation acute ischemic stroke[J/OL]. BMC Med Imaging,2024,24:178[2026-03-14]. https://doi.org/10.1186/s12880-024-01365-7. [53] ZENG W X,LI W,HUANG K B,et al. Predicting futile recanalization,malignant cerebral edema,and cerebral herniation using intelligible ensemble machine learning following mechanical thrombectomy for acute ischemic stroke[J/OL]. Front Neurol,2022,13:982783[2026-03-14]. https://doi.org/10.3389/fneur.2022.982783. [54] XIE Y,JIANG B,GONG E H,et al. Use of gradient boosting machine learning to predict patient outcome in acute ischemic stroke on the basis of imaging,demographic,and clinical information[J]. AJR Am J Roentgenol,2019,212(1):44-51. [55] SHEN H,HUASEN B B,KILLINGSWORTH M C,et al. Introducing the futile recanalization prediction score(FRPS):a novel approach to predict and mitigate ineffective recanalization after endovascular treatment of acute ischemic stroke[J]. Neurol Int,2024,16(3):605-619. [56] NIE X M,YANG J X,LI X X,et al. Prediction of futile recanalisation after endovascular treatment in acute ischaemic stroke:development and validation of a hybrid machine learning model[J]. Stroke Vasc Neurol,2024,9(6):631-639. [57] CAO R Y,LU Y,LI W,et al. Dynamic CTA-based whole-brain arterial-venous collateral assessment for predicting futile recanalization in acute ischemic stroke[J/OL]. Aging Dis,2025[2026-03-14]. https://doi.org/10.14336/AD.2025.0540. |
| [1] | 何丹丹, 李俭, 王春娟, 李姝雅. 我国急性缺血性卒中脑细胞保护剂基础实验与临床研究的挑战与突破[J]. 中国卒中杂志, 2026, 21(5): 517-524. |
| [2] | 程希玥, 赵璟妍, 王春娟. 依达拉奉右莰醇在急性缺血性卒中脑细胞保护中的研究进展[J]. 中国卒中杂志, 2026, 21(5): 526-532. |
| [3] | 杨千千, 张眉扬, 陆瑶, 周东杨, 王正一蕾, 单舒乙, 刘晨辉, 王伊龙, 管玲. 米诺环素在急性缺血性卒中中的抗神经炎症与脑细胞保护研究进展:从机制到临床证据[J]. 中国卒中杂志, 2026, 21(5): 533-542. |
| [4] | 何丹丹, 李姝雅. 基于STAIR原则的PSD-95靶向脑细胞保护剂在急性缺血性卒中中的研究进展[J]. 中国卒中杂志, 2026, 21(5): 543-552. |
| [5] | 李汶逸, 姜季委, 任琦玮, 王琳琳, 赵敏, 徐俊. 载脂蛋白E基因多态性与卒中后认知功能变化的相关性研究[J]. 中国卒中杂志, 2026, 21(5): 577-584. |
| [6] | 刘元昊, 吴磊, 杨欢, 朱佳颖, 李亚哲. 不同取栓装置在急性缺血性卒中治疗中的有效性与安全性:1项回顾性比较研究[J]. 中国卒中杂志, 2026, 21(4): 463-470. |
| [7] | 欧茹, 刘益民, 徐智坚, 黄文纯. 血管源性腔隙灶对急性缺血性卒中患者生命健康状况的动态影响[J]. 中国卒中杂志, 2026, 21(3): 312-319. |
| [8] | 李荔, 段振晖, 高爱华, 潘宋斌. 老年急性缺血性卒中患者衰弱指数、营养风险与静脉溶栓后院内感染风险的相关性分析及预测模型构建[J]. 中国卒中杂志, 2026, 21(3): 331-337. |
| [9] | 国家神经系统疾病医疗质量控制中心, 中国卒中学会医疗质量管理与促进分会, 中国卒中学会神经介入分会. 急性缺血性卒中再灌注治疗医疗质量评价与改进专家建议(2026)[J]. 中国卒中杂志, 2026, 21(3): 338-352. |
| [10] | 姚莉, 吴川杰. 2026美国心脏学会/美国卒中学会急性缺血性卒中患者早期管理指南血管内治疗要点与解读[J]. 中国卒中杂志, 2026, 21(2): 234-239. |
| [11] | 何丹丹, 许淑红, 李姝雅. 急性缺血性卒中标准时间窗内新型静脉溶栓药物临床研究及展望[J]. 中国卒中杂志, 2026, 21(1): 24-29. |
| [12] | 黄旭阳, 李润辉. 替奈普酶与阿替普酶治疗急性缺血性卒中短期神经功能恢复比较:线性混合效应模型分析[J]. 中国卒中杂志, 2026, 21(1): 31-37. |
| [13] | 何丹丹, 冯宝玉, 刘改芬, 谷鸿秋, 李姝雅. 中性粒细胞与淋巴细胞比值对急性缺血性卒中静脉溶栓患者预后的预测价值:基于3项随机对照试验的个体患者数据分析[J]. 中国卒中杂志, 2026, 21(1): 38-47. |
| [14] | 赵敏, 冯宝玉, 何丹丹, 王维聪, 李姝雅. 瑞替普酶与阿替普酶治疗急性缺血性卒中合并心律失常患者的有效性及安全性比较[J]. 中国卒中杂志, 2026, 21(1): 48-54. |
| [15] | 何丹丹, 李姝雅. 急性缺血性卒中静脉溶栓中外周血炎症指标与预后的研究进展[J]. 中国卒中杂志, 2026, 21(1): 55-64. |
| 阅读次数 | ||||||
|
全文 |
|
|||||
|
摘要 |
|
|||||