Journal article
Repeat thrombectomy after large vessel re-occlusion: a propensity score matched analysis of technical and clinical outcomes
Journal of neurointerventional surgery, Vol.17(e1), pp.e102-e102
01/2025
DOI: 10.1136/jnis-2023-021197
PMID: 38238008
Abstract
Endovascular 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.
This 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.
Out 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).
Short-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.
Details
- Title: Subtitle
- Repeat thrombectomy after large vessel re-occlusion: a propensity score matched analysis of technical and clinical outcomes
- Creators
- Youssef M Zohdy - Emory UniversityHassan Saad - Emory UniversityBrian M Howard - Emory UniversityC Michael Cawley - Emory UniversityAqueel Pabaney - Emory UniversityFeras Akbik - Emory University School of MedicineLaurie Dimisko - Emory UniversityIlko Maier - Nova Southeastern UniversityAlejandro M Spiotta - Medical University of South CarolinaPascal Jabbour - Thomas Jefferson UniversityStacey Q Wolfe - Wake Forest UniversityAnsaar Rai - West Virginia University HospitalsJoon-Tae Kim - Chonnam National UniversityJustin Mascitelli - The University of Texas Health Science Center at San AntonioRobert M Starke - University of MiamiAmir Shaban - University of IowaShinichi Yoshimura - Hyogo Medical UniversityReade De Leacy - Icahn School of Medicine at Mount SinaiPeter Kan - The University of Texas Medical Branch at GalvestonIsabel Fragata - Unidade Local de Saúde de São JoséAdam J Polifka - University of FloridaAdam S Arthur - University of Tennessee Health Science CenterMin S Park - Barrow Neurological InstituteCharles Matouk - University of New HavenMichael R Levitt - University of WashingtonStavropoula I Tjoumakaris - Thomas Jefferson University HospitalJan Liman - University of GöttingenVanesha Waiters - Morehouse School of MedicineGustavo Pradilla - Emory UniversityKyle M Fargen - Wake Forest UniversityAli Alawieh - Emory UniversityJonathan A Grossberg - Emory UniversitySTAR Collaborators
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.17(e1), pp.e102-e102
- DOI
- 10.1136/jnis-2023-021197
- PMID
- 38238008
- NLM abbreviation
- J Neurointerv Surg
- eISSN
- 1759-8486
- Language
- English
- Electronic publication date
- 01/17/2024
- Date published
- 01/2025
- Academic Unit
- Neurology
- Record Identifier
- 9984548408402771
Metrics
6 Record Views