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  • Repeated mechanical thrombectomy in short-term large vessel occlusion recurrence: multicenter study and systematic review of the literature

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Ischemic Stroke
Original research
Repeated mechanical thrombectomy in short-term large vessel occlusion recurrence: multicenter study and systematic review of the literature
  1. Hanna Styczen1,
  2. Christian Maegerlein2,
  3. Leonard LL Yeo3,
  4. Christin Clajus4,
  5. Andreas Kastrup5,
  6. Nuran Abdullayev6,
  7. Daniel Behme7,
  8. Christoph Johannes Maurer8,
  9. Lukas Meyer9,
  10. Lukas Goertz10,
  11. Benno Ikenberg11,
  12. Benjamin Y Q Tan3,
  13. Donald Lobsien4,
  14. Panagiotis Papanagiotou12,
  15. Christoph Kabbasch6,
  16. Amelie Carolina Hesse7,
  17. Ansgar Berlis8,
  18. Jens Fiehler9,
  19. Sebastian Fischer13,
  20. Michael Forsting1,
  21. Volker Maus13
  1. 1 Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
  2. 2 Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
  3. 3 Division of Neurology, National University Health System, Singapore
  4. 4 Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
  5. 5 Department of Neurology, Klinikum Bremen, Bremen, Germany
  6. 6 Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
  7. 7 Institute for Diagnostic and Interventional Neuroradiology, Georg-August-University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
  8. 8 Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany
  9. 9 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  10. 10 Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
  11. 11 Department of Neurology, Klinikum rechts der Isar, Munich, Germany
  12. 12 Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
  13. 13 Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
  1. Correspondence to Dr Hanna Styczen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen 45147, Germany; hanna.styczen{at}gmx.de

Abstract

Background Data on the frequency and outcome of repeated mechanical thrombectomy (MT) in patients with short-term re-occlusion of intracranial vessels is limited. Addressing this subject, we report our multicenter experience with a systematic review of the literature.

Methods A retrospective analysis was conducted of consecutive acute stroke patients treated with MT repeatedly within 30 days at 10 tertiary care centers between January 2007 and January 2020. Baseline demographics, etiology of stroke, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at 90 days were noted. Additionally, a systematic review of reports with repeated MT due to large vessel occlusion (LVO) recurrence was performed.

Results We identified 30 out of 7844 (0.4%) patients who received two thrombectomy procedures within 30 days due to recurrent LVO. Through systematic review, three publications of 28 participants met the criteria for inclusion. Combined, a total of 58 participants were analyzed: cardioembolic events were the most common etiology for the first (65.5%) and second LVO (60.3%), respectively. Median baseline NIHSS (National Institutes of Health Stroke Scale) was 13 (IQR 8–16) before the first MT and 15 (IQR 11–19) before the second MT (p=0.031). Successful reperfusion was achieved in 91.4% after the first MT and in 86.2% patients after the second MT (p=0.377). The rate of functional independence (mRS 0–2) was 46% at 90 days after the second procedure.

Conclusion Repeated MT in short-term recurrent LVO is a rarity but appears to be safe and effective. The second thrombectomy should be pursued with the same extensive effort as the first procedure as these patients may achieve similar good outcomes.

  • stroke
  • thrombectomy

https://doi.org/10.1136/neurintsurg-2020-015938

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    Footnotes

    • Correction notice Since the online publication of this article, it was noticed that author Michael Forsting was missing an affiliation. This has now been corrected.

    • Contributors Conception and design: VM. Acquisition of data: VM, HS, CM, LLLY, CC, AK, NA, DB, CJM, LM. Analysis and interpretation of data: VM, HS, LG, BI, BYQT, DL, PP, CK, ACH, AB, JF, SF, MF. Drafting the article: HS. All authors have read and approved the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval According to the guidelines of the ethics committee (Medical Faculty, University of Duisburg Essen, University Hospital Essen, 19-9013-BO), ethical approval was given for this anonymous retrospective study, which was conducted in accordance with the Declaration of Helsinki. A patient’s consent for treatment was obtained according to the individual institutional guidelines. Due to the retrospective nature of the study additional informed consent was deemed unnecessary.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.