Abstract
Introduction Endovascular thrombectomy (EVT) remains the standard of care for acute large vessel occlusion stroke. In a subset of patients, the target vessel could re-occlude following successful recanalization requiring consideration of repeat EVT. In this study, we use a large real-world patient cohort to study the incidence of repeat thrombectomy as well as clinical and technical outcomes in this subset. Methods This is an international multicenter study including retrospectively reviewed cohort of patients undergoing EVT for ischemic stroke at 21 centers in the United States and globally as part of multicenter registry between 01/2013 and 03/2022. Patients undergoing single or repeat thrombectomy were included irrespective of whether thrombolysis was administered, location of thrombus, onset to groin time or thrombectomy technique. Patients undergoing another thrombectomy after 30 days of index thrombectomy or for a different vascular territory were excluded. Propensity score matching was used to compare patients undergoing single versus repeat thrombectomy. The primary outcome was the modified Rankin score (mRS) at 90 days, and secondary outcomes were successful recanalization defined as Thrombolysis in Cerebral Ischemia (TICI) score of 2B or above, incidence of postprocedural hemorrhage and mortality. Results A total of 7387 patients met inclusion criteria of which 1.8% (N=90) underwent repeat thrombectomy for the same vascular territory within 30 days and were included in this study. Of this subset, the average time to re-occlusion was 5.3±7.3 days, and 41 (45.6%) required re-EVT within 24hrs. Using propensity score matching for age, baseline comorbidities, admission NIHSS, and IV-tPA use, patients undergoing repeat thrombectomy had comparable rate of good outcome defined as mRS 0-2 at 90 days compare to patients undergoing single procedure (27% versus 31%, p=0.57), similar mortality (17% versus 20%, p=0.58) but higher rate of symptomatic intracranial hemorrhage (11% versus 5%, p=0.025). When comparing the change in NIHSS before and after the second thrombectomy, there was a significant reduction in NIHSS between pre-procedure and discharge (ΔNIHSS = (-)5±11, one sample t-test, p=0.006). The rate of successful recanalization was similar in patients undergoing single or repeat thrombectomy (78% versus 80%, p= 0.78) and between index thrombectomy and repeat thrombectomy for the same patient (79% versus 80%, p = 0.78). The rate of hemorrhagic conversion was similar regardless if intracranial stenting was performed. Conclusions Repeat EVT for patients with re-occlusion within 30 days of thrombectomy is associated with favorable improvement in NIHSS, similar functional outcomes to patients undergoing single EVT, but has significantly higher risk of hemorrhagic conversion. Disclosures Y. Zohdy: None. H. Saad: None. B. Howard: None. C. Cawley: None. A. Pabaney: None. T. Garzon-Muvdi: None. I. Maier: None. A. Spiotta: None. P. Jabbour: None. S. Wolfe: None. A. Rai: None. J. Kim: None. J. Mascitelli: None. R. Starke: None. A. Shaban: None. S. Yoshimura: None. R. De Leacy: None. P. Kan: None. I. Fragata: None. A. Polifka: None. A. Arthur: None. M. Park: None. C. Matouk: None. M. Levitt: None. S. Tjoumakaris: None. J. Liman: None. K. Fargen: None. A. Alawieh: None. J. Grossberg: None.