Etiology of recurrent large vessel occlusions treated with repeated thrombectomy

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Repeated mechanical thrombectomy for acute stroke treatment in individual patients has been proven feasible. However, less is known about the etiology of recurrent vessel occlusions after prior thrombectomy. We aimed to understand if the etiology of such recurrent events differs from the first stroke. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Retrospectively, we identified all patients at our center who received a repeated mechanical thrombectomy between 2007 and 2019. Clinical data were retrieved from medical records. Etiology of stroke was evaluated retrospectively, and angiographic studies were revisited. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Twenty-three patients (1.5%) were identified. Median age was 68 years (IQR 56–77). Median NIHSS at first admission was 11 points (IQR 5–15). In nine cases (39.1%), the recurrent vessel occlusion was located exactly at the same position as the prior occlusion. Overall, five (21.7%) patients had a remarkable extracranial pathology as likely cause of stroke recurrence. In 16 patients (69.6%), the etiology of the first stroke and its recurrence was considered as likely being the same, mostly of cardioembolic or unknown origin. In the seven remaining patients (30.4%), the cause of stroke possibly differed from the first event, with five patients (21.7%) having a postinterventional intracranial intimal lesion as possible cause of stroke. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Incidence of repeated thrombectomy was low. However, the high number of patients with known origin of stroke etiology raises the question how their monitoring may be optimized. The number of patients with remarkable extracranial pathologies or intracranial endothelial lesions supports current clinical practice to pay attention to final angiographic series. </jats:p></jats:sec>

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

“…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. Ikenberg et al 13 had 1.5% incidence, found 5 patients (21.7%) with recurrent thrombectomy within 24 h and 14 patients (60.9%) within two weeks. Mosimann et al noted that the incidence of early reocclusion after 48 h was 2.3% in patients after successful thrombectomy and Marto et al found that the incidence of early reocclusion after 24 h was 6.6%.…”

“…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.…”

“…6 Meza et al and Fandler et al utilized the stent-retrievers in the first and in repeat endovascular procedures. 7,10 In the study of Ikenberg et al, 13 Solumbra technique was utilized in 73.9% of repeat thrombectomies. In our study, aspiration thrombectomy alone was performed in six patients for recurrent thrombectomy (86%) with TICI 3 recanalization and combination treatment with aspiration thrombectomy and stent-retriever was performed in one patient (14%).…”

“…3,11 Bhogal et al 12 found that 86.5% of the strokes were deemed as being cardioembolic in nature. Ikenberg et al 13 reported 69.6% of patients, where the etiology of the first stroke and its recurrence was considered as likely being the same, mostly of cardioembolic or unknown origin. Similarly Pirson et al 14 found that 67% of patients receiving recurrent MT had cardioembolic source of stroke.…”

“…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.…”