Mechanical thrombectomy for recurrent large vessel occlusion

Bhogal, Paul; AlMatter, Muhammad; Hellstern, Victoria; Pérez, Marta Aguilar; Ganslandt, Oliver; Bäzner, Hansjörg; Henkes, Hans

doi:10.1016/j.jocn.2019.05.010

Cited by 12 publications

(21 citation statements)

References 44 publications

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“…Stroke cause was mainly cardioembolic (67%), which is in line with the findings from the previous case series on rEVT (66%, 43%, 87%). [6][7][8] In our series, most patients were on secondary prevention at the time of the recurrent LVO. However, in patients using anticoagulants, international normalized ratio often was not in the therapeutic range, which may have contributed to a recurrent event.…”

Section: Discussionmentioning

confidence: 76%

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Repeated Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Pirson

Oostenbrugge

Zwam

et al. 2020

Stroke

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Background and Purpose— Patients with acute ischemic stroke treated with endovascular thrombectomy may be treated with repeat endovascular thrombectomy (rEVT) in case of recurrent large vessel occlusion. Data on safety and efficacy of these interventions is scarce. Our aim is to report on frequency, timing, and outcome of rEVT in a large nation-wide multicenter registry. Methods— In the Netherlands, all patients with endovascular thrombectomy have been registered since 2002 (MR CLEAN Pretrial registry, MR CLEAN Trial [Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands], and MR CLEAN Registry). We retrospectively reviewed these databases for anterior circulation rEVT cases. Patient characteristics, procedural data, and functional outcome (modified Rankin Scale at 90 days) were analyzed. Results— Of 3928 patients treated between 2002 and 2017, 27 (0.7%) underwent rEVT. Median time between first and second procedure was 78 (1–1122) days; 11/27 patients were re-treated within 30 days. Cardioembolism was the most common etiology (18 patients [67%]). In 19 patients (70%), recurrent occlusion occurred ipsilateral to previous occlusion. At 90 days after rEVT procedure, 44% of the patients had achieved functional independence (modified Rankin Scale score of 0–2), and 33% had died. Adverse events were 2/27 (7.4%) intracranial hemorrhage, 1/27 (3.7%) stroke progression, and 1/27 (3.7%) pneumonia. Conclusions— In this large nationwide cohort of patients with acute ischemic stroke treated with endovascular thrombectomy, rEVT was rare. Stroke cause was mainly cardio-embolic, and most recurrent large vessel occlusions in which rEVT was performed occurred ipsilateral. Although there probably is a selection bias on repeated treatment in case of recurrent large vessel occlusion, rEVT appears safe, with similar outcome as in single-treated cases.

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Section: Discussionmentioning

confidence: 76%

“…Bhogal et al 8 report similar outcome for patients treated for contralateral LVO's. We agree with the authors that a larger sample size is needed before conclusions can be drawn.…”

Section: Stroke February 2020mentioning

confidence: 80%

Repeated Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Pirson

Oostenbrugge

Zwam

et al. 2020

Stroke

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“…To the best of our knowledge, there are five series of 15, 23, 25, 27 and 35 patients (Table 3) and several case reports regarding endovascular treatment of recurrent LVO. [5][6][7][8][9][10][11][12][13][14] In the available series to date, Bouslama et al 5 found that the incidence of recurrent LVO was 2% with the median time interval between the first and last procedure of recurrent LVO being 18 days. Similarly, Weber et al 11 found the incidence of recurrent LVO as 1.4%; however, the mean time interval between the first and second MT was 147 days.…”

Section: Discussionmentioning

confidence: 99%

“…Data regarding the outcome of patients treated with repeated MT for recurrent LVO are also limited, and only a few series and several case reports have been published to date. [5][6][7][8][9][10][11][12][13][14] These reports vary in the interval of re-thrombectomy, from early recurrence (<1 day) up to over a year. 5,9,[11][12][13][14] In the present study, we report our experience with the endovascular treatment of patients with recurrent LVO, including three cases of target vessel re-occlusion.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Data on the treatment with recurrent mechanical thrombectomy of patients with acute ischemic stroke with recurrent large vessel occlusion are limited. We report our experience with recurrent mechanical thrombectomy for recurrent large vessel occlusion. Methods During the period between May 2013 and August 2018, data on patients with recurrent large vessel occlusion were collected. Baseline clinical characteristics, recanalization technique, recanalization rates and clinical outcomes of patients with recurrent large vessel occlusion treated with mechanical thrombectomy were analyzed. Patients with recurrent large vessel occlusion treated with mechanical thrombectomy were compared with patients who underwent single mechanical thrombectomy. Results During the study period, 7 of 474 patients (1.5%) were treated with mechanical thrombectomy for recurrent large vessel occlusion. The mean age of these patients was 64.4 (±7.9) years, and the mean time interval between thrombectomies was 47 (±48) h. The median baseline National Institutes of Health Stroke Scale (NIHSS) was 12 (range 5–24) before the first and 20 (range 3–34) before the second procedure; the mean NIHSS at discharge was 5 (range 2–25). Good clinical outcome after repeated mechanical thrombectomy defined as modified Rankin scale of 0–2 was achieved in 29% of patients at three months of follow-up. Conclusions Repeat mechanical thrombectomy is a rare procedure, but appears to be a feasible, safe and effective treatment option in patients with acute ischemic stroke and early recurrent large vessel occlusion.

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“…Our patient with acute posterior circulation infarction and underlying ICAD underwent ET of the same occluded BA thrice within 24 h. Data on repeated ET for early recurrent stroke caused by the occlusion of the same affected vessel are scarce. To our knowledge, there are only a few case reports [3-5, 12] and two retrospective studies with repeated ET due to recurrent LVO [13, 14], but mostly in the anterior circulation. Our case report is the first on repeated ET within the BA.…”

Section: Discussionmentioning

confidence: 99%

A Case of Successful Intravenous Thrombolysis Bridged with Repeated Endovascular Treatment in Acute Basilar Artery Occlusion

et al. 2020

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Acute basilar artery occlusion (BAO) is a neurological emergency that has a high rate of mortality and poor functional outcome. Endovascular therapy (ET) is the gold standard therapy for large vessel occlusion stroke of the anterior circulation. Whether ET can also be effectively and safely performed in early recurrent large vessel occlusion, especially in BAO, is unclear. We describe a case of successful recanalization and independent functional outcome of a BAO patient treated with intravenous thrombolysis combined with repeated ET. The patients was a 32-year-old man with a history of heavy smoking and drinking who presented to the Emergency Department with dizziness and hypertension, and progressed over the next 13 h to left hemiparesis and mild dysarthria with an NIHSS score of 7. CT angiography demonstrated occlusion of the proximal basilar artery (BA). Intravenous alteplase was given followed by ET. The first intervention failed and over the next 8 h, the patient’s NIHSS score increased to 12. A second attempt with balloon angioplasty managed to reconstitute arterial blood flow with a severe residual stenosis of the proximal BA. Subsequently, the patient progressed into deep coma with reocclusion of the BA demonstrated on transcranial Doppler. A third intervention with emergent stenting resulted in complete recanalization of the BA and excellent neurological recovery. This patient received three endovascular treatments within 24 h due to reocclusion of the BA and achieved good outcomes. In conclusion, repeated ET for early recurrent BAO is feasible in carefully selected patients.

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Mechanical thrombectomy for recurrent large vessel occlusion

Cited by 12 publications

References 44 publications

Repeated Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Repeated Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

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

A Case of Successful Intravenous Thrombolysis Bridged with Repeated Endovascular Treatment in Acute Basilar Artery Occlusion

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