“Incidence and Clinico-Radiological Correlations of Early Arterial Reocclusion After Successful Thrombectomy in Acute Ischemic Stroke”

Santana, Daniel; Laredo, Carlos; Renú, Arturo; Rudilosso, Salvatore; Llull, Laura; Urra, Xabier; Obach, Vı́ctor; López-Rueda, Antonio; Macías, Napoleón; Amaro, Sergio

doi:10.1007/s12975-020-00816-x

Cited by 11 publications

(13 citation statements)

References 19 publications

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“…38,39 However, it should still be taken into account when explaining the infarct growth after endovascular treatment. This has been demonstrated by Santana et el, 40 who found that reocclusion is associated with an increased infarct growth (adjusted OR = 8.5; 95% CI, 2.04-34.70). Similarly, distal embolization and infarction in new territory can contribute to the infarct growth.…”

Section: Discussionsupporting

confidence: 56%

Infarct Growth despite Successful Endovascular Reperfusion in Acute Ischemic Stroke: A Meta-analysis

Bala

Ospel

Mulpur

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND: Infarct volume inversely correlates with good recovery in stroke. The magnitude and predictors of infarct growth despite successful reperfusion via endovascular treatment are not known. PURPOSE:We aimed to summarize the extent of infarct growth in patients with acute stroke who achieved successful reperfusion (TICI 2b-3) after endovascular treatment. DATA SOURCES:We performed a systematic review and meta-analysis by searching MEDLINE and Google Scholar for articles published up to October 31, 2020.STUDY SELECTION: Studies of .10 patients reporting baseline and post-endovascular treatment infarct volumes on MR imaging were included. Only patients with TICI 2b-3 were included. We calculated infarct growth at a study level as the difference between baseline and follow-up MR imaging infarct volumes.DATA ANALYSIS: Our search yielded 345 studies, and we included 10 studies reporting on 973 patients having undergone endovascular treatment who achieved successful reperfusion. DATA SYNTHESIS:The mean baseline infarct volume was 19.5 mL, while the mean final infarct volume was 37.5 mL. A TICI 2b reperfusion grade was achieved in 24% of patients, and TICI 2c or 3 in 76%. The pooled mean infarct growth was 14.8 mL (95% CI, 7.9-21.7 mL). Meta-regression showed higher infarct growth in studies that reported higher baseline infarct volumes, higher rates of incomplete reperfusion (modified TICI 2b), and longer onset-to-reperfusion times. LIMITATIONS: Significant heterogeneity among studies was noted and might be driven by the difference in infarct growth between early-and late-treatment studies.CONCLUSIONS: These results suggest considerable infarct growth despite successful endovascular treatment reperfusion and call for a faster workflow and the need for specific therapies to limit infarct growth.

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Section: Discussionsupporting

confidence: 56%

Infarct Growth despite Successful Endovascular Reperfusion in Acute Ischemic Stroke: A Meta-analysis

Bala

Ospel

Mulpur

et al. 2021

AJNR Am J Neuroradiol

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“…The mean age of the patients experiencing reocclusion in the included cohorts15 16 20 33–36 ranged from 63 to 72 years. Most patients had an occlusion in the anterior circulation (75/82 patients, 91.5%) and large artery atherosclerosis was the most frequently identified stroke mechanism (33/58 patients, 56.9%).…”

Section: Resultsmentioning

confidence: 99%

“…We explored the following risk factors of reocclusion: stroke etiology (four studies, 53 patients with reocclusion of 1441 patients)15 16 35 36; and treatment with IVT (four studies, 63 patients with reocclusion of 1398 patients) 15 16 35 36…”

Section: Resultsmentioning

confidence: 99%

“…Risk factors specifically related to the technical procedure included higher number of device passes,15 residual thrombus/stenosis after EVT,16 and transient reocclusion during EVT 15 35. Acute carotid stenting or balloon angioplasty was associated with increased risk of reocclusion in one of the two included cohorts providing information on reocclusion rates stratified according to this procedure 15 36. Acute intracranial permanent stenting was not associated with a different rate of reocclusion,15 but information was scarce.…”

Section: Resultsmentioning

confidence: 99%

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Reocclusion after successful endovascular treatment in acute ischemic stroke: systematic review and meta-analysis

Oliveira

Correia

Marto

et al. 2022

J NeuroIntervent Surg

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BackgroundEndovascular treatment (EVT) is the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO).ObjectiveTo systematically review the available data on: (1) incidence, predictors, and outcomes of patients with reocclusion after successful EVT for AIS and, (2) the characteristics, complications, and outcomes of patients with reocclusion treated with repeated EVT (rEVT) within 30 days of the first procedure.MethodsPubMed was searched (between January 2012 and April 2021) to identify studies reporting reocclusion following successful EVT (Thrombolysis in Cerebral Infarction ≥2b) in patients with AIS due to LVO. Pooled incidence of reocclusion per 100 patients with successful recanalization following EVT was calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Extracted incidences of reocclusion according to etiology and use of intravenous thrombolysis were pooled using random-effects meta-analytic models.ResultsA total of 840 studies was identified and seven studies qualified for the quantitative analysis, which described 91 same-vessel reocclusions occurring within the first 7 days after treatment among 2067 patients (4.9%; 95% CI 3% to 7%, I2=70.2%). Large vessel atherosclerosis was associated with an increased risk of reocclusion (OR=3.44, 95% CI 1.12 to 10.61, I2=50%). We identified 90 patients treated with rEVT for recurrent LVO, described in five studies. The rates of procedural complications, mortality, and unfavorable functional outcome at 3 months were 18.0%, 18.9%, and 60.3%, respectively.ConclusionIn cohorts of patients with AIS due to LVO, 5% of patients experienced reocclusion within 7 days after successful EVT. Repeated EVT can be a safe and effective treatment for selected patients with reocclusion.

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“…Despite these limitations, early arterial recanalization following AIS has been shown to improve cerebral blood perfusion, functional outcome, and survival. The conventional window for reperfusion has not been challenged beyond these time points mostly due to the risk of ischemia/reperfusion injury [ 7 ], hemorrhagic transformation risk [ 8 ], early arterial reocclusion [ 9 ], and other associated deleterious outcomes [ 10 ]. Most AIS patients fail to receive intervention due to delays that increase the door-to-needle time (DNT) or door-to-puncture time (DPT), e.g., failure in early diagnosis, onset of unidentified symptoms, and/or other associated limitations in current stroke protocols [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Macrophage Infiltration Reduces Neurodegeneration and Improves Stroke Recovery after Delayed Recanalization in Rats

Pang

Matei

Peng

et al. 2022

Oxidative Medicine and Cellular Longevity

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Background. Recent cerebrovascular recanalization therapy clinical trials have validated delayed recanalization in patients outside of the conventional window. However, a paucity of information on the pathophysiology of delayed recanalization and favorable outcomes remains. Since macrophages are extensively studied in tissue repair, we anticipate that they may play a critical role in delayed recanalization after ischemic stroke. Methods. In adult male Sprague-Dawley rats, two ischemic stroke groups were used: permanent middle cerebral artery occlusion (pMCAO) and delayed recanalization at 3 days following middle cerebral artery occlusion (rMCAO). To evaluate outcome, brain morphology, neurological function, macrophage infiltration, angiogenesis, and neurodegeneration were reported. Confirming the role of macrophages, after their depletion, we assessed angiogenesis and neurodegeneration after delayed recanalization. Results. No significant difference was observed in the rate of hemorrhage or animal mortality among pMCAO and rMCAO groups. Delayed recanalization increased angiogenesis, reduced infarct volumes and neurodegeneration, and improved neurological outcomes compared to nonrecanalized groups. In rMCAO groups, macrophage infiltration contributed to increased angiogenesis, which was characterized by increased vascular endothelial growth factor A and platelet-derived growth factor B. Confirming these links, macrophage depletion reduced angiogenesis, inflammation, neuronal survival in the peri-infarct region, and favorable outcome following delayed recanalization. Conclusion. If properly selected, delayed recanalization at day 3 postinfarct can significantly improve the neurological outcome after ischemic stroke. The sanguineous exposure of the infarct/peri-infarct to macrophages was essential for favorable outcomes after delayed recanalization at 3 days following ischemic stroke.

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“Incidence and Clinico-Radiological Correlations of Early Arterial Reocclusion After Successful Thrombectomy in Acute Ischemic Stroke”

Cited by 11 publications

References 19 publications

Infarct Growth despite Successful Endovascular Reperfusion in Acute Ischemic Stroke: A Meta-analysis

Infarct Growth despite Successful Endovascular Reperfusion in Acute Ischemic Stroke: A Meta-analysis

Reocclusion after successful endovascular treatment in acute ischemic stroke: systematic review and meta-analysis

Macrophage Infiltration Reduces Neurodegeneration and Improves Stroke Recovery after Delayed Recanalization in Rats

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