Nonlinear association between platelet distribution width and futile recanalization in acute ischemic stroke patients undergoing mechanical thrombectomy

Abstract

Platelet distribution width (PDW) is increasingly recognized as a potential biomarker in cardiovascular and cerebrovascular diseases. We, therefore, sought to clarify whether baseline PDW values predict futile recanalization (FR) among acute ischemic stroke (AIS) patients receiving endovascular thrombectomy (EVT). We performed a retrospective cohort analysis at the Affiliated Hospital of Xuzhou Medical University, enrolling patients who underwent EVT and attained successful recanalization within 24 h of symptom onset from October 2018 to May 2025. FR was defined as a modified Rankin Scale score of 3–6 during a 90-day period. Blood samples were obtained at the time of admission and before the initiation of treatment. Multivariable logistic regression models were utilized to assess the relationship between PDW and FR. A restricted cubic spline was employed to assess linearity and examine the characteristics of the dose–response relationship. Of the 439 included patients, 226 (51.5%) developed FR. A nonlinear (J-shaped) correlation was identified between PDW and FR ( P = 0.009), with an inflection point at a PDW of 15.8%. No association with FR was observed below this threshold (OR 0.99, 95% CI 0.97–1.02; P = 0.600). In contrast, for PDW ≥ 15.8%, each 0.1-unit increment in PDW correlated with a 20% elevated risk of FR (OR 1.20, 95% CI 1.05–1.36; P = 0.006). Subgroup analyses demonstrated consistent results across populations (all P > 0.05). Admission PDW exhibited a J-shaped association with FR in AIS patients treated with thrombectomy, with a critical turning point observed at approximately 15.8%.