Repeated Mechanical Thrombectomy in Recurrent Large Vessel Occlusion Acute Ischemic Stroke

Abstract

Background: Endovascular therapy has been proven effective for the treatment of large vessel occlusion strokes (LVOS). However, the feasibility and potential benefits of repeat thrombectomy for recurrent stroke is unclear. We aim to report our experience with repeat thrombectomy for recurrent LVOS. Methods: We reviewed our prospectively collected endovascular database for patients who underwent repeated mechanical thrombectomy. Baseline characteristics, procedural data and outcomes were evaluated. Patients with repeat thrombectomy were compared to patients with single thrombectomy. For patients with repeat thrombectomy, imaging and procedural variables were compared between first and last procedures. Results: Out of 697 patients treated within the study period, 15 patients (2%) had repeat thrombectomies (14 treated twice and one thrice). The mean age was 63 ± 15 years and 40% were males. The median time between the first and last procedure was 18 (1-278) days. Cardioembolism (66%) was the most common etiology, followed by intracranial atherosclerosis (13%) and large vessel atherosclerosis (6%). At 90 days after the last thrombectomy, 60% of patients achieved a modified Rankin Scale score of 0-2 and 20% were deceased. There were no statistically significant differences in demographics, stroke severity, time from last known normal to puncture, reperfusion rates, hemorrhagic complications, good clinical outcomes and mortality between patients who underwent repeat thrombectomy and those who had a single thrombectomy. Conclusion: In properly selected patients suffering recurrent LVOS, repeated mechanical thrombectomy appears to be feasible and safe. A previous thrombectomy should not discourage aggressive treatment as these patients may achieve similar rates of good clinical outcomes as those who undergo single thrombectomy.

Predictors of Unexpected Early Reocclusion After Successful Mechanical Thrombectomy in Acute Ischemic Stroke Patients

“…11 Indeed, effective repeated thrombectomy for recurrent large vessel occlusions has been reported in 2% of cases in a registry of 697 patients. 19 In this study of comparable size, the overall reocclusion rate was similar to ours but lower in the 24-to 48-hour range, which may relate to the low number of M2 occlusions in their collective (n=4). Moreover, the dominant…”

“…Prompt identification of early recocclusion may lead to timely repeated thrombectomy and thus improve outcome. 19 The rates of early (24-48 hours) and late (90 days) good functional outcome and the rate of repeated thrombectomy were low in our series, stressing the importance of identifying reocclusion as early as possible to be able to offer a timely rescue therapy and improve clinical outcome. 11 Indeed, effective repeated thrombectomy for recurrent large vessel occlusions has been reported in 2% of cases in a registry of 697 patients.…”

Repeated Mechanical Thrombectomy of Recurrent Large Vessel Occlusion: Case Report and Brief Review of the Literature

“…To our knowledge there are reports of repeated MT in patients with AIS [3,6]. However, no patients with AIS complicated with uremia undergoing repeated MT treatments in a short time were reported.…”

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

“…Moreover, in case of early relapse, intravenous thrombolysis is formally contraindicated for the treatment of recurrent, within 3 months, ischemic stroke . Although repeat mechanical thrombectomy has been shown to be both effective and safe, the minority of recurrent strokes will harbor a proximal arterial occlusion . Therefore, treatment of such cases remains largely empirical and based on expert opinion.…”

“…7 Although repeat mechanical thrombectomy has been shown to be both effective and safe, the minority of recurrent strokes will harbor a proximal arterial occlusion. 8,9 Therefore, treatment of such cases remains largely empirical and based on expert opinion. Occasionally, the combination of anticoagulants and antiplatelets is an option, particularly for cases with multiple recurrent strokes not responding to antiplatelet monotherapy.…”