In the field of cerebrovascular disorders, the management of acute ischemic stroke, particularly those caused by large vessel occlusion, has been revolutionized by mechanical thrombectomy, often used in conjunction with intravenous thrombolysis. Although these interventions frequently achieve successful recanalization and generally predict positive outcomes, many patients do not experience functional independence after 90 days, a condition known as futile recanalization. Despite successful large vessel recanalization, the underlying causes of this disappointing outcome remain poorly understood. Various contributing factors such as impaired cerebral autoregulation, extensive hypoperfusion, inadequate collateral circulation, and microvascular obstructions, known as the no-reflow phenomenon, have been identified.

This Research Topic aims to delve into the no-reflow phenomenon that occurs after large vessel recanalization in acute ischemic stroke to enhance understanding of the associated microvascular impairments and to refine prognosis. By focusing on the identification and association of specific biomarkers, alongside clinical and neuroradiological characteristics, the goal is to elucidate the mechanisms that impede optimal recovery despite apparent success in revascularization procedures.

To gather further insights into this clinical enigma, we welcome articles addressing, but not limited to, the following themes:

- Analysis of the role of cerebral autoregulation in post-recanalization outcomes.

- Assessment of collateral circulation's impact on stroke recovery and the no-reflow phenomenon.

- Neuroradiological evidence and biomarkers predictive of poor outcomes despite recanalization.

- Long-term clinical outcomes and rehabilitation strategies for patients experiencing futile recanalization.

- Comparative studies on direct mechanical thrombectomy versus combined approaches with thrombolysis in managing no-reflow.

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Understanding the No-Reflow Phenomenon in Acute Ischemic Stroke