{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:11:08Z","timestamp":1793034668656,"version":"4.5.0"},"reference-count":56,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T00:00:00Z","timestamp":1695686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Futile recanalization (FR) continues to raise concern despite the success of endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). Understanding the prevalence of FR and identifying associated factors are crucial for refining patient prognoses and optimizing management strategies. Objectives: This study aims to comprehensively assess the pooled prevalence of FR, explore the diverse factors connected with FR, and establish the association of FR with long-term clinical outcomes among AIS patients undergoing EVT. Materials and Methods: Incorporating studies focusing on FR following EVT in AIS patients, we conducted a random-effect meta-analysis to assess the pooled prevalence and its association with various clinical and imaging risk factors linked to FR. Summary estimates were compiled and study heterogeneity was explored. Results: Our comprehensive meta-analysis, involving 11,700 AIS patients undergoing EVT, revealed a significant pooled prevalence of FR at 51%, with a range of 48% to 54% (Effect Size [ES]: 51%; 95% Confidence Interval [CI]: 48\u201354%; z = 47.66; p &lt; 0.001). Numerous clinical factors demonstrated robust correlations with FR, including atrial fibrillation (Odds Ratio [OR]: 1.39, 95% CI 1.22 1.59; p &lt; 0.001), hypertension (OR 1.65, 95% CI 1.41 1.92; p &lt; 0.001), diabetes mellitus (OR 1.71, 95% CI 1.47 1.99; p &lt; 0.001), previous stroke or transient ischemic attack (OR 1.298, 95% CI 1.06 1.59; p = 0.012), prior anticoagulant usage (OR 1.33, 95% CI 1.08 1.63; p = 0.007), cardioembolic strokes (OR 1.34, 95% CI 1.10 1.63; p = 0.003), and general anesthesia (OR 1.53, 95% CI 1.35 1.74; p &lt; 0.001). Conversely, FR exhibited reduced likelihoods of smoking (OR 0.66, 95% CI 0.57 0.77; p &lt; 0.001), good collaterals (OR 0.33, 95% CI 0.23 0.49; p &lt; 0.001), male sex (OR 0.87, 95% CI 0.77 0.97; p = 0.016), and intravenous thrombolysis (IVT) (OR 0.75, 95% CI 0.66 0.86; p &lt; 0.001). FR was strongly associated with increasing age (standardized mean difference [SMD] 0.49, 95% CI 0.42 0.56; p &lt; 0.0001), baseline systolic blood pressure (SMD 0.20, 95% CI 0.13 0.27; p &lt; 0.001), baseline National Institute of Health Stroke Severity Score (SMD 0.75, 95% CI: 0.65 0.86; p &lt; 0.001), onset-to-treatment time (SMD 0.217, 95% CI 0.13 0.30; p &lt; 0.001), onset-to-recanalization time (SMD 0.38, 95% CI 0.19; 0.57; p &lt; 0.001), and baseline blood glucose (SMD 0.31, 95% CI 0.22 0.41; p &lt; 0.001), while displaying a negative association with reduced baseline Alberta Stroke Program Early CT Score (ASPECTS) (SMD \u22120.37, 95% CI \u22120.46 \u22120.27; p &lt; 0.001). Regarding clinical outcomes, FR was significantly associated with increased odds of symptomatic intracranial hemorrhages (OR 7.37, 95% CI 4.89 11.12; p &lt; 0.001), hemorrhagic transformations (OR 2.98, 95% CI 2.37 3.75; p &lt; 0.001), and 90-day mortality (OR 19.24, 95% CI 1.57 235.18; p = 0.021). Conclusions: The substantial prevalence of FR, standing at approximately 51%, warrants clinical consideration. These findings underscore the complexity of FR in AIS patients and highlight the importance of tailoring management strategies based on individual risk factors and clinical profiles.<\/jats:p>","DOI":"10.3390\/life13101965","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T08:55:01Z","timestamp":1695718501000},"page":"1965","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Comprehensive Meta-Analysis of Futile Recanalization in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy: Prevalence, Factors, and Clinical Outcomes"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9769-8184","authenticated-orcid":false,"given":"Helen","family":"Shen","sequence":"first","affiliation":[{"name":"Global Health Neurology Lab, Sydney, NSW 2150, Australia"},{"name":"South Western Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW 2052, Australia"},{"name":"Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6125-1183","authenticated-orcid":false,"given":"Murray C.","family":"Killingsworth","sequence":"additional","affiliation":[{"name":"Global Health Neurology Lab, Sydney, NSW 2150, Australia"},{"name":"South Western Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW 2052, Australia"},{"name":"Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia"},{"name":"NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia"},{"name":"Department of Anatomical Pathology, NSW Health Pathology, Cell-Based Disease Intervention Research Group, Ingham Institute for Applied Medical Research and Liverpool Hospital, Liverpool, NSW 2170, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9783-3628","authenticated-orcid":false,"given":"Sonu M. M.","family":"Bhaskar","sequence":"additional","affiliation":[{"name":"Global Health Neurology Lab, Sydney, NSW 2150, Australia"},{"name":"Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia"},{"name":"NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia"},{"name":"Department of Neurology & Neurophysiology, Liverpool Hospital & South Western Sydney Local Health District (SWSLHD), Sydney, NSW 2170, Australia"},{"name":"Department of Neurology, National Cerebral and Cardiovascular Center (NCVC), Suita 564-8565, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,26]]},"reference":[{"key":"ref_1","unstructured":"GBD 2019 Stroke Collaborators (2021). Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol., 20, 795\u2013820."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal","year":"2016","journal-title":"Lancet"},{"key":"ref_3","first-page":"e000257","article-title":"Risk Factors of Futile Recanalization Following Endovascular Treatment in Patients With Large-Vessel Occlusion: Systematic Review and Meta-Analysis","volume":"2","author":"Shahid","year":"2022","journal-title":"Stroke Vasc. Interv. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Nicolini, E., Iacobucci, M., De Michele, M., Ciacciarelli, A., Berto, I., Petraglia, L., Falcou, A., Cirelli, C., Biraschi, F., and Lorenzano, S. (2023). No-reflow phenomenon in acute ischemic stroke: An angiographic evaluation. Neurol. Sci.","DOI":"10.1007\/s10072-023-06879-6"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s13760-021-01805-z","article-title":"Digital subtraction angiography in cerebrovascular disease: Current practice and perspectives on diagnosis, acute treatment and prognosis","volume":"122","author":"Shaban","year":"2022","journal-title":"Acta Neurol. Belg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Deng, G., Chu, Y.-H., Xiao, J., Shang, K., Zhou, L.-Q., Qin, C., and Tian, D.-S. (2023). Risk Factors, Pathophysiologic Mechanisms, and Potential Treatment Strategies of Futile Recanalization after Endovascular Therapy in Acute Ischemic Stroke. Aging Dis.","DOI":"10.14336\/AD.2023.0321-1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1136\/neurintsurg-2021-017963","article-title":"Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: A meta-analysis","volume":"14","author":"Deng","year":"2022","journal-title":"J. Neurointerv. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"107083","DOI":"10.1016\/j.jstrokecerebrovasdis.2023.107083","article-title":"Incidence and predictors of poor functional outcome despite complete recanalisation following endovascular thrombectomy for acute ischaemic stroke","volume":"32","author":"Dhillon","year":"2023","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"110731","DOI":"10.1016\/j.ejrad.2023.110731","article-title":"A DWI-based radiomics-clinical machine learning model to preoperatively predict the futile recanalization after endovascular treatment of acute basilar artery occlusion patients","volume":"161","author":"Luo","year":"2023","journal-title":"Eur. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s00062-022-01166-x","article-title":"Full Reperfusion Without Functional Independence After Mechanical Thrombectomy in the Anterior Circulation","volume":"32","author":"Weyland","year":"2022","journal-title":"Clin. Neuroradiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1161\/STROKEAHA.118.021320","article-title":"Number of Stent Retriever Passes Associated With Futile Recanalization in Acute Stroke","volume":"49","author":"Baek","year":"2018","journal-title":"Stroke"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e467","DOI":"10.1212\/WNL.0000000000007859","article-title":"Neutrophil count predicts poor outcome despite recanalization after endovascular therapy","volume":"93","author":"Boisseau","year":"2019","journal-title":"Neurology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3252","DOI":"10.1161\/STROKEAHA.117.018270","article-title":"Predictors of good outcome after endovascular therapy for vertebrobasilar occlusion stroke","volume":"48","author":"Bouslama","year":"2017","journal-title":"Stroke"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.neurol.2022.10.003","article-title":"TICI-RANKIN mismatch: Poor clinical outcome despite complete endovascular reperfusion in the ETIS Registry","volume":"179","author":"Dong","year":"2023","journal-title":"Rev. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1161\/STROKEAHA.114.008598","article-title":"Combined Multimodal Computed Tomography Score Correlates With Futile Recanalization After Thrombectomy in Patients With Acute Stroke","volume":"46","author":"Parrilla","year":"2015","journal-title":"Stroke"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"963111","DOI":"10.3389\/fimmu.2022.963111","article-title":"Postoperative neutrophil-lymphocyte ratio predicts unfavorable outcome of acute ischemic stroke patients who achieve complete reperfusion after thrombectomy","volume":"13","author":"Feng","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1007\/s00415-016-8366-y","article-title":"Leukoaraiosis is a predictor of futile recanalization in acute ischemic stroke","volume":"264","author":"Gilberti","year":"2017","journal-title":"J. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1136\/neurintsurg-2018-014576","article-title":"Impact of procedural time on clinical and angiographic outcomes in patients with acute ischemic stroke receiving endovascular treatment","volume":"11","author":"Hassan","year":"2019","journal-title":"J. NeuroInterv. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2684","DOI":"10.1111\/ene.15898","article-title":"Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients","volume":"30","author":"Heitkamp","year":"2023","journal-title":"Eur. J. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s00234-018-2016-2","article-title":"Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial","volume":"60","author":"Hussein","year":"2018","journal-title":"Neuroradiology"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lattanzi, S., Norata, D., Divani, A.A., Di Napoli, M., Broggi, S., Rocchi, C., Ortega-Gutierrez, S., Mansueto, G., and Silvestrini, M. (2021). Systemic Inflammatory Response Index and Futile Recanalization in Patients with Ischemic Stroke Undergoing Endovascular Treatment. Brain Sci., 11.","DOI":"10.3390\/brainsci11091164"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lee, S.-H., Kim, B.J., Han, M.-K., Park, T.H., Lee, K.B., Lee, B.-C., Yu, K.-H., Oh, M.S., Cha, J.K., and Kim, D.-H. (2019). Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity. BMC Neurol., 19.","DOI":"10.1186\/s12883-019-1237-2"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Liao, J.s., Guo, C., Zhang, B., Yang, J., Zi, W., and Li, J.l. (2023). Low neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict favorable outcomes after endovascular treatment in acute basilar artery occlusion: Subgroup analysis of the BASILAR registry. BMC Neurol., 23.","DOI":"10.1186\/s12883-023-03161-2"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"968037","DOI":"10.3389\/fneur.2022.968037","article-title":"A visualized nomogram to online predict futile recanalization after endovascular thrombectomy in basilar artery occlusion stroke","volume":"13","author":"Lin","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1136\/neurintsurg-2014-011525","article-title":"Predictors of poor outcome despite recanalization: A multiple regression analysis of the NASA registry","volume":"8","author":"Linfante","year":"2016","journal-title":"J. NeuroInterv. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e752","DOI":"10.1212\/WNL.0000000000011268","article-title":"Association of Interleukin-6 Levels and Futile Reperfusion After Mechanical Thrombectomy","volume":"96","author":"Mechtouff","year":"2021","journal-title":"Neurology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1136\/neurintsurg-2018-014516","article-title":"Mechanical thrombectomy for basilar artery occlusion: Efficacy, outcomes, and futile recanalization in comparison with the anterior circulation","volume":"11","author":"Meinel","year":"2019","journal-title":"J. Neurointerv. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1170215","DOI":"10.3389\/fneur.2023.1170215","article-title":"Stress hyperglycemia as a modifiable predictor of futile recanalization in patients undergoing mechanical thrombectomy for acute ischemic stroke","volume":"14","author":"Merlino","year":"2023","journal-title":"Front. Neurol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"907","DOI":"10.3389\/fneur.2020.00907","article-title":"Predictors of Poor Outcome Despite Successful Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusions Within 6 h of Symptom Onset","volume":"11","author":"Mohammaden","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"958236","DOI":"10.3389\/fneur.2022.958236","article-title":"Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows","volume":"13","author":"Ni","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"403726","DOI":"10.1155\/2015\/403726","article-title":"Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers","volume":"2015","author":"Ozdemir","year":"2015","journal-title":"Sci. World J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"831386","DOI":"10.3389\/fneur.2022.831386","article-title":"Posterior Circulation ASPECTS on CT Angiography Predicts Futile Recanalization of Endovascular Thrombectomy for Acute Basilar Artery Occlusion","volume":"13","author":"Ouyang","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"704088","DOI":"10.3389\/fneur.2021.704088","article-title":"Multiple-Factor Analyses of Futile Recanalization in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy","volume":"12","author":"Pan","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1161\/STROKEAHA.119.028511","article-title":"Brain atrophy and the risk of futile endovascular reperfusion in acute ischemic stroke","volume":"51","author":"Pedraza","year":"2020","journal-title":"Stroke"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.3174\/ajnr.A5236","article-title":"e-ASPECTS Correlates with and Is Predictive of Outcome after Mechanical Thrombectomy","volume":"38","author":"Pfaff","year":"2017","journal-title":"Am. J. Neuroradiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1161\/STROKEAHA.114.005603","article-title":"Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes","volume":"45","author":"Shi","year":"2014","journal-title":"Stroke"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1159\/000356213","article-title":"Age dependency of successful recanalization in anterior circulation stroke: The ENDOSTROKE study","volume":"36","author":"Singer","year":"2013","journal-title":"Cerebrovasc. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1007\/s00415-021-10680-w","article-title":"Cystatin C predicts futile recanalization in patients with acute ischemic stroke after endovascular treatment","volume":"269","author":"Su","year":"2022","journal-title":"J. Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1055\/s-0037-1612600","article-title":"Predictors of poor outcome after successful mechanical thrombectomy in patients with acute anterior circulation stroke","volume":"1","author":"Tajima","year":"2017","journal-title":"J. Clin. Interv. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1159\/000369835","article-title":"Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke","volume":"3","author":"Tateishi","year":"2015","journal-title":"Interv. Neurol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e748","DOI":"10.1016\/j.wneu.2020.04.139","article-title":"Large infarct volume post thrombectomy: Characteristics, outcomes, and predictors","volume":"139","author":"Tonetti","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"89","DOI":"10.54029\/2023kep","article-title":"The CHA2DS2-VASc risk score predicts futile recanalization after endovascular treatment in patients with acute ischemic stroke","volume":"28","author":"Vatan","year":"2023","journal-title":"Neurol. Asia"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e576","DOI":"10.1016\/j.wneu.2019.09.098","article-title":"Factors Promoting Futile Recanalization After Stent Retriever Thrombectomy for Stroke Affecting the Anterior Circulation: A Retrospective Analysis","volume":"133","author":"Wang","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"78","DOI":"10.31083\/j.jin2203078","article-title":"Red Cell Distribution Width and Futile Recanalization in Individuals with Acute Ischemic Stroke following Endovascular Treatment","volume":"22","author":"Wang","year":"2023","journal-title":"J. Integr. Neurosci."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Xie, Y., Liu, X., Gu, H., Zhong, G., Wen, Y., He, J., and Zhong, X. (2023). Influencing factors of futile recanalization after endovascular therapy for cerebral infarction with posterior circulation occlusion of large vessels: A retrospective study. BMC Neurol., 23.","DOI":"10.1186\/s12883-023-03166-x"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"105067","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105067","article-title":"Predictors of Futile Recanalization After Endovascular Treatment in Patients with Acute Ischemic Stroke in a Multicenter Registry Study","volume":"29","author":"Xu","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1159\/000510804","article-title":"Biomarkers of Unfavorable Outcome in Acute Ischemic Stroke Patients with Successful Recanalization by Endovascular Thrombectomy","volume":"49","author":"Zang","year":"2020","journal-title":"Cerebrovasc. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1136\/neurintsurg-2021-017765","article-title":"Predictors of futile recanalization in patients undergoing endovascular treatment in the DIRECT-MT trial","volume":"14","author":"Zhou","year":"2022","journal-title":"J. NeuroInterv. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0197-2456(95)00134-4","article-title":"Assessing the quality of reports of randomized clinical trials: Is blinding necessary?","volume":"17","author":"Jadad","year":"1996","journal-title":"Control. Clin. Trials"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e2331","DOI":"10.1212\/WNL.0000000000010614","article-title":"Association of initial imaging modality and futile recanalization after thrombectomy","volume":"95","author":"Meinel","year":"2020","journal-title":"Neurology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1136\/postgradmedj-2019-136413","article-title":"Trends in acute stroke presentations to an emergency department: Implications for specific communities in accessing acute stroke care services","volume":"95","author":"Bhaskar","year":"2019","journal-title":"Postgrad. Med. J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1111\/acem.14204","article-title":"Effect of prehospital workflow optimization on treatment delays and clinical outcomes in acute ischemic stroke: A systematic review and meta-analysis","volume":"28","author":"Chowdhury","year":"2021","journal-title":"Acad. Emerg. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1111\/ejn.14955","article-title":"Cerebral collaterals in acute ischaemia: Implications for acute ischaemic stroke patients receiving reperfusion therapy","volume":"53","author":"Ravindran","year":"2021","journal-title":"Eur. J. Neurosci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3020","DOI":"10.1161\/STR.0000000000000074","article-title":"2015 American Heart Association\/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment","volume":"46","author":"Powers","year":"2015","journal-title":"Stroke"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2558","DOI":"10.1007\/s42399-021-01069-x","article-title":"Optimising Prehospital Pathways to Improve Acute Stroke Reperfusion Therapy Delivery: Systems-Based Approaches","volume":"3","author":"Chowdhury","year":"2021","journal-title":"SN Compr. Clin. Med."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/10\/1965\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:58:35Z","timestamp":1760129915000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/10\/1965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,26]]},"references-count":56,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["life13101965"],"URL":"https:\/\/doi.org\/10.3390\/life13101965","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,26]]}}}