Recurrent Large Vessel Occlusion After Successful Recanalization From Mechanical Thrombectomy: Risk Factors and Outcomes After Repeat Mechanical Thrombectomy.
Publication/Presentation Date
4-18-2025
Abstract
BACKGROUND AND OBJECTIVES: Mechanical thrombectomy (MT) is the standard of care in patients with large vessel occlusion (LVO). Despite successful recanalization, about 5% of patients are at risk for developing recurrent LVO. Our study identifies predictors of recurrent LVO and outcomes after repeat MT.
METHODS: This was a retrospective multicenter study of patients who underwent MT for LVO. Cases were patients who developed recurrent LVO after successful recanalization (thrombolysis in cerebral infarction ≥2b) and controls were patients who did not develop recurrent LVO. Descriptive statistics and univariate analyses were used to compare both cohorts.
RESULTS: Six hundred twenty nine patients achieved successful recanalization after MT. A total of 13 patients developed recurrent LVO. On univariate analysis, age (odds ratio [OR]: 0.96, 95% CI: 0.93-0.99), initiation of antithrombotics (OR: 0.09, 95% CI: 0.03-0.30), number of attempts (OR: 0.97, 95% CI: 0.96-0.99; P < .05), and postoperative statin use (OR: 0.21, 95% CI: 0.06-0.70) were significantly associated with decreased odds of recurrent LVO. Presence of underlying disease in target vessel (OR: 3.23, 95% CI: 1.03-10.06) and thrombolysis in cerebral infarction 3 revascularization (OR: 5.08, 95% CI: 1.54-16.71) were associated with increased odds of recurrent LVO. Ten patients (76.9%) who developed recurrent LVO had a thrombus in the same vessel as the initial occlusion. Most patients developed reocclusion within 24 hours of the initial MT (n = 8, 61.5%). Five patients (38.5%) were functionally independent on discharge (modified Rankin Score 0-2).
CONCLUSION: Our study identified predictors of recurrent LVO after successful recanalization from MT. Further validation of risk factors of recurrent LVO could help cater antithrombotic regimen in this cohort.
ISSN
2332-4260
Published In/Presented At
Roy, J. M., Musmar, B., Kata, R., Ahmed, M. T., Patil, S., Mina, S., Momin, A., Theofanis, T., Ramchand, P., Schmidt, R. F., Mackenzie, L., Ghosh, R., Kozak, O., Zarzour, H., Tjoumakaris, S. I., Gooch, M. R., Rosenwasser, R. H., & Jabbour, P. M. (2025). Recurrent Large Vessel Occlusion After Successful Recanalization From Mechanical Thrombectomy: Risk Factors and Outcomes After Repeat Mechanical Thrombectomy. Operative neurosurgery (Hagerstown, Md.), 10.1227/ons.0000000000001575. Advance online publication. https://doi.org/10.1227/ons.0000000000001575
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
40249189
Department(s)
Administration and Leadership
Document Type
Article