Research progress and novel interventional strategies for futile recanalization in endovascular treatment of acute ischemic stroke

Endovascular therapy has become a milestone breakthrough in the diagnosis and treatment of acute ischemic stroke. However, it still faces a major challenge in current clinical practice: nearly half of patients achieve successful recanalization of the occluded vessels yet fail to experience improvement in neurological outcomes. This phenomenon is defined as futile reperfusion. The occurrence of futile reperfusion is closely associated with multiple underlying pathophysiological mechanisms, including the no-reflow phenomenon, reperfusion injury, early arterial reocclusion, poor collateral circulation, and hemorrhagic transformation. With continuous advances in endovascular treatment techniques, strategies to mitigate futile reperfusion in patients with large vessel occlusion are rapidly evolving. Notably, the emerging concept of "retro-bridging" therapy marks a new stage in targeted intervention following endovascular treatment, aiming to address futile reperfusion more effectively. Based on a systematic analysis of the mechanisms underlying futile reperfusion, this review focuses on novel intervention strategies developed in recent years, with the goal of providing novel research perspectives and identifying potential therapeutic targets to improve the overall efficacy of endovascular treatment.