Repeated Endovascular Thrombectomy in Patients with Acute Ischemic Stroke in a Single Center

Lee, Hyun Jin; Kwak, Hyo Sung; Chung, Gyung Ho; Park, Jung Soo

doi:10.1016/j.jstrokecerebrovasdis.2020.105457

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…At 90 days, the mRS score for 4 of the 6 did not show worsening, 1 showed improvement, and 1 had a worse mRS score after a third stroke. A recent study by Lee et al also concluded that ipsilateral repeat thrombectomies produced a significantly better clinical outcome when compared to that with contralateral repeat thrombectomies (83.3% vs 16.7, p = 0.027), 19 but none of the patients was older than 90 years.…”

Section: Discussionmentioning

confidence: 92%

“…The HERMES meta-analysis favored endovascular thrombectomy even in patient populations older than 80 years, noting that it significantly reduced disability at 90 days as compared to that in the standard medical treatment arm of the study. 19 This meta-analysis included 198 patients with an age ≥ 80 years, and the rate of an mRS score of 0 to 2 at 90 days was 29.8% in the endovascular group and 13.9% in the control group (OR 3.68, 95% CI 1.95–6.92). However, the rate of an mRS score of 0 to 2 at 90 days in the endovascular group decreased with advancing age: 50 to 59 years, 50.0%; 60 to 69 years, 51.9%; 70 to 79 years, 43.1%; and ≥ 80 years, 29.8%.…”

Section: Discussionmentioning

confidence: 99%

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Favorable outcome of repeat mechanical thrombectomy in a geriatric patient: illustrative case

Alsarah¹,

Hussein²,

Carlson

2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND The authors presented their experience with a case of repeat thrombectomy in a 93-year-old patient who showed a favorable outcome after recurrent large vessel occlusion treated with emergency mechanical thrombectomy. OBSERVATIONS Mechanical thrombectomy has been proven to be effective in treating large vessel occlusion types of ischemic stroke. Most of the patient populations involved in the thrombectomy-related studies were younger than 80 years. In addition, recurrent mechanical thrombectomy is not a common procedure in clinical practice. This unusual case demonstrated the potential to achieve a favorable outcome with thrombectomy even in a patient older than 85 years with recurrent large vessel occlusion. LESSONS There can be a favorable neurological outcome after one or repeat thrombectomies for geriatric patients older than 90 years, and age should not be a deterrent to treatment.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Favorable outcome of repeat mechanical thrombectomy in a geriatric patient: illustrative case

Alsarah¹,

Hussein²,

Carlson

2021

Journal of Neurosurgery: Case Lessons

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Repeated reperfusion treatment in recurrent ischemic stroke: A retrospective single-center case series

Dell’Aera

Giammello

Caragliano

et al. 2022

Journal of the Neurological Sciences

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Repeat thrombectomy after large vessel re-occlusion: a propensity score matched analysis of technical and clinical outcomes

Zohdy,

Saad,

Howard

et al. 2024

J NeuroIntervent Surg

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BackgroundEndovascular 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.MethodsThis 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.ResultsOut 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).ConclusionShort-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.

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Repeated Endovascular Thrombectomy in Patients with Acute Ischemic Stroke in a Single Center

Cited by 4 publications

References 23 publications

Favorable outcome of repeat mechanical thrombectomy in a geriatric patient: illustrative case

Favorable outcome of repeat mechanical thrombectomy in a geriatric patient: illustrative case

Repeated reperfusion treatment in recurrent ischemic stroke: A retrospective single-center case series

Repeat thrombectomy after large vessel re-occlusion: a propensity score matched analysis of technical and clinical outcomes

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