Objective:

To determine whether automated net water uptake (NWU) measured on admission non-contrast computed tomography (CT) independently predicts futile recanalization (FR) in anterior-circulation large vessel occlusion (LVO) stroke treated with endovascular thrombectomy (EVT).

Approach:

• Study Design: Retrospective single-center cohort study including patients with anterior circulation LVO treated with EVT from January 2023 to April 2025.
• Data Collection: Automated platform (VEOcore/MRAY) provided Alberta Stroke Program Early CT Score (ASPECTS), perfusion metrics, and NWU.
• Statistical Analysis: Logistic regression analyzed associations with FR; ROC analysis evaluated discrimination and identified optimal NWU thresholds.

Key Findings:

• 62 out of 91 patients (68.1%) achieved recanalization with a 90-day modified Rankin Scale (mRS) score of 0–4.
• 29 patients (31.9%) met criteria for FR (mRS score 5–6).
• Patients with FR were older (81.6 ± 8.3 years) and had more severe strokes (median NIHSS score of 16).
• NWU was significantly higher in FR cases (21.9%) compared to non-FR cases (3.0%).
• NWU remained independently associated with FR (odds ratio 1.15).

Interpretation:

The findings suggest that higher NWU on admission CT may indicate a greater likelihood of FR in patients with anterior circulation LVO undergoing EVT. This relationship highlights the potential of NWU as a predictive biomarker for treatment outcomes, emphasizing the need for further investigation into its clinical utility.

Limitations:

• Single-center study may limit generalizability.
• Retrospective design may introduce selection bias.

Conclusion:

Automated NWU measurement may warrant prospective multicenter validation. ---