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Introduction Futile recanalization (FR) is defined as thrombolysis in cerebral infarction (TICI) 2B-3 after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) with long term poor neurologic outcomes. Multiple predictors of poor neurologic outcome after AIS despite technical success have been suggested, though this remains unresolved.Methods Data were prospectively collected at two urban academic medical centers from January 2022-June 2024, including patient demographics; stroke location; pre-intervention NIH Stroke Scale (NIHSS); baseline, discharge, and 90-day modified Rankin Score (mRS); and TICI score. Time specific factors, including door-to-needle, door-to-reperfusion, and estimated last known well (LKW)-to-reperfusion were also determined. FR was defined as TICI 2B, 2C, or 3 recanalization with 90-day mRS ≥ 3. Wilcoxon, χ 2, Fisher’s exact, Shapiro-Wilk tests, and logistic regression were used for statistical inference, with p<0.05 consider significant.Results Of 5789 stroke codes, 256 underwent EVT (4.4%). Of these, 236 (92.1%) had TICI 2B or better recanalization and 155 had available 90-day mRS outcomes available. The FR group was older (median age 74 years [63-81.5] versus 61 [55.5-71], p<0.001), with no difference in sex (48.6% females versus 36.2%, p=0.21). There was a statistically significantly higher proportion of baseline mRS >1 patients in the FR group (19.8% versus 2.2%, p=0.01). In the non-FR group, there were no baseline mRS values > 2. Median pre-intervention NIHSS was significantly higher in the FR group (median 17 [12-22] versus 12 [6-17], p<0.001). There was no difference in the distribution of LVO locations between groups (p=0.18); non-tandem MCA was most common (77.5% versus 78.7%, p=0.86). Between FR and non-FR groups, there was no statistically significant difference in door-to-groin time (median 37 minutes [25.5-78.5] versus 55 [29-103], p=0.08); door-to-recanalization time (median 76 minutes [61-120] versus 96 [64.5-134], p=0.22); estimated LKW-to-recanalization time (467.5 minutes [295.5-776] versus 499 [258-801], p=0.70); LKW-to-door time (388.5 minutes [208.3-639] versus 369 [176.5-645.5], p=0.76); or TICI 2B-3 rates (p=0.33). There was no difference in ‘excellent’ (TICI 2C or 3) recanalization (50.5% versus 61.7%, p=0.27). On univariate logistic regression, age (p<0.001), pre-NIHSS (p<0.001), and baseline mRS >2 (p=0.02) were significant predictors of poor outcome at 90-days. On multivariate logistic regression age (OR 1.4 [1.01-1.08], p=0.01) and pre-NIHSS (OR 1.10 [1.03-1.17], p=0.003) were significant predictors, with a trend towards mRS<2 (OR 0.16 [0.009-0.92], p=0.09), whereas door-to-groin time (p=0.17), and TICI 2C/3 (p=0.22) were not.Conclusion Probability of FR was most influenced by patient age, stroke severity, and baseline neurologic function.Disclosures J. Breton: None. K. Shrestha: None. J. Alexander: None. M. O’Donnell Clyne: None. M. McCullough: None. A. Stemer: None. S. Alqahtani: None. S. Sur: None. D. Felbaum: None.Abstract E-269 Figure 1