Endovascular treatment of acute ischemic stroke in patients with recurrent intracranial large vessel occlusion

Klepanec, Andrej; Haršany, Ján; Haring, Jozef; Mako, Miroslav; Hoferica, Matúš; Rusina, Matej; Cisar, J; Krastev, Georgi

doi:10.1177/1591019920911532

Cited by 4 publications

(1 citation statement)

References 20 publications

(52 reference statements)

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“…To date, investigations into the effect of previous stroke on thrombectomy outcomes have been limited by small sample sizes, and have reported conflicting results. When comparing outcomes between patients undergoing repeat EVT and those undergoing first time EVT, three small studies have reported similar outcomes between groups 3–6. In contrast, a retrospective analysis of EVT patients with a previous history of stroke (as opposed to only those whom underwent previous EVT) reported worse outcomes in patients with previous strokes 7…”

Section: Introductionmentioning

confidence: 99%

Laterality of previous stoke affects endovascular thrombectomy outcomes

Bageac

Gershon

Chada

et al. 2022

J NeuroIntervent Surg

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BackgroundInvestigations into the effect of previous stroke on thrombectomy outcomes have yielded conflicting results, and are limited by small sample sizes. We present the results of a large single center retrospective study aimed at investigating the effect of chronic stroke laterality on thrombectomy outcomes.MethodsA prospectively maintained database was queried for all thrombectomy cases conducted between December 2014 and January 2020, and patient imaging was prospectively reviewed for evidence of prior supratentorial infarction. Procedural, clinical, and demographic characteristics were recorded, and good clinical outcome was defined as a 90 day modified Rankin Scale (mRS) score of <2 or mRS score unchanged if baseline was >2.ResultsThe final analysis cohort included 555 patients, 79 of whom were found to have radiographic evidence of prior chronic infarcts. On univariate analysis, patients with any chronic supratentorial infarct achieved a lower rate of good clinical outcome than patients with no chronic infarct (22.8% vs 41.0%, p=0.0021). With regard to subgroups, this difference remained only in patients with ipsilateral (14.3%, p=0.0018) and bilateral (11.8%, p=0.015) lesions. Patients with chronic contralateral supratentorial infarcts were no less likely to achieve good outcomes (40.7%, p=0.98). After multivariate regression controlling for age, sex, and baseline mRS, chronic ipsilateral infarcts (OR 0.22, CI 0.07 to 0.67) and chronic bilateral infarcts (OR 0.19, CI 0.04 to 0.85) were the only independent predictors of poor outcome in endovascular thrombectomy patients.ConclusionsIn this single center retrospective study of thrombectomy patients with chronic supratentorial infarcts, the laterality of the previous stroke significantly affected the likelihood of good clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

Laterality of previous stoke affects endovascular thrombectomy outcomes

Bageac

Gershon

Chada

et al. 2022

J NeuroIntervent Surg

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Repeated Endovascular Thrombectomy in Patients with Acute Ischemic Stroke in a Single Center

Lee

Kwak

Chung

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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Repeat thrombectomy after large vessel re-occlusion: a propensity score matched analysis of technical and clinical outcomes

Zohdy,

Saad,

Howard

et al. 2024

J NeuroIntervent Surg

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BackgroundEndovascular thrombectomy (EVT) remains the standard of care for acute large vessel occlusion (LVO) stroke. However, the safety and efficacy of repeat thrombectomy (rEVT) in recurrent LVO remains unclear. This study uses a large real-world patient cohort to study technical and clinical outcomes after rEVT.MethodsThis is a retrospective cohort study including patients who underwent thrombectomy between January 2013 and December 2022. Data were included from 21 comprehensive stroke centers globally through the Stroke Thrombectomy and Aneurysm Registry (STAR). Patients undergoing single EVT or rEVT within 30 days of LVO stroke were included in the study. Propensity score matching was used to compare patients undergoing single EVT versus rEVT.ResultsOut of a total of 7387 patients who underwent thrombectomy for LVO stroke, 90 (1.2%) patients underwent rEVT for the same vascular territory within 30 days. The median (IQR) time to re-occlusion was 2 (1–7) days. Compared with a matched cohort of patients undergoing a single EVT procedure, patients undergoing rEVT had a comparable rate of good functional outcome and mortality rate, but a higher rate of symptomatic intracranial hemorrhage (sICH). There was a significant reduction in the National Institutes of Health Stroke Scale (NIHSS) score of patients who underwent rEVT at discharge compared with baseline (−4.8±11.4; P=0.006). The rate of successful recanalization was similar in the single thrombectomy and rEVT groups (78% vs 80%, P=0.171) and between index and rEVT performed on the same patient (79% vs 80%; P=0.593).ConclusionShort-interval rEVT is associated with an improvement in the NIHSS score following large vessel re-occlusion. Compared with single thrombectomy, there was a higher rate of sICH with rEVT, but without a significant impact on rates of functional independence or mortality.

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Endovascular treatment of acute ischemic stroke in patients with recurrent intracranial large vessel occlusion

Cited by 4 publications

References 20 publications

Laterality of previous stoke affects endovascular thrombectomy outcomes

Laterality of previous stoke affects endovascular thrombectomy outcomes

Repeated Endovascular Thrombectomy in Patients with Acute Ischemic Stroke in a Single Center

Repeat thrombectomy after large vessel re-occlusion: a propensity score matched analysis of technical and clinical outcomes

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