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

Abstract Background Timely recognition of futile recanalization might enable a prompter response and thus improve outcomes in patients receiving successful thrombectomy. This study aims to evaluate whether postoperative fibrinogen‐to‐albumin ratio (FAR) could act as an indicator of futile recanalization. Methods This is a single‐center, retrospective analysis of patients with acute anterior circulation large‐vessel occlusion and successful thrombectomy between May 2019 and June 2022. FAR was defined as postoperative blood levels of fibrinogen divided by those of albumin, and dichotomized into high and low levels based on the Youden index. Futile recanalization was defined as patients achieving a successful recanalization with a modified Rankin Scale score of 3–6 at 90 days. Multivariable logistic regression was used to assess the association of FAR with futile recanalization. Results A total of 255 patients were enrolled, amongst which 87 patients (34.1%) had high postoperative FAR. Futile recanalization was more prevalent among patients with high FAR compared to those with low FAR (74.7% vs. 53.0%, p = .001). After adjusting for potential confounders, high postoperative FAR was found to independently correspond with the occurrence of futile recanalization (adjusted OR 2.40, 95%CI 1.18–4.87, p = .015). This association was consistently observed regardless of prior antithrombotic therapy, treatment of intravenous thrombolysis, occlusion site, time from symptom onset to groin puncture, and reperfusion status. Conclusion Our findings support high postoperative FAR serving as an indicator of futile recanalization in patients with anterior circulation large‐vessel occlusion and successful thrombectomy.