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

Background: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
Competing Interests: Competing interests: AS is a consultant for Stryker, Penumbra, Terumo, and RapidAI. PJ is a consultant for Balt, Cerus endovascular, Microvention, and Medtronic. SQW is on the AANS board of directors, and AHA associate editor. JM is a consultant for Stryker. RDL received research funding from Hypervention, Kaneka Medical, Siemens, and SNIS Foundation, is a consultant for Stryker, Imperative Care, Cerenovus, and Asahi Intec, is a shareholder in Synchron, Endostream, Q’Apel and Spartan Micro, and is on the JNIS editoral board. PK is a consultant for Stryker, Imperative Care, and Microvention and is on the JNIS editorial board. AJP is a consultant for Stryker and Depuy Synthes. ASA received research funding from Balt, Medtronic, Microvention, Penumbra, and Siemens, is a consultant for Arsenal, Balt, Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, and Stryker, and is a shareholder in Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI. MSP served on a data monitoring board for Medtronic. CM is a consultant for Silk Road, Penumbra, Microvention, and Stryker. MRL received research funding from Stryker and Medtronic, is a consultant for Medtronic, adviser consultant for Aeaean, and innovative adviser for Metis, received travel support from Penumbra, is on the JNIS editorial board, is a shareholder in Hyperion Surgical, Propia, Synchron, Cerebrotech, Fluid Biomed, and Sterotaxis, and received equipment, material, drugs, medical writing, gifts and/or other services from Stryker and Medtronic. SIT is a consultant for Medtronic and Microvention and received payments for expert testimony. GP is a consultant for Stryker Corporation. KMF is on the JNIS editorial board. JAG received research funding from Georgia Research Alliance, Emory Medical Care Foundation, Department of Defense, Neurosurgery Catalyst and is a shareholder in NTI and Cognition. All other authors have no personal, financial, or institutional disclosures.
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