Recurrent Large Vessel Occlusion After Successful Recanalization From Mechanical Thrombectomy: Risk Factors and Outcomes After Repeat Mechanical Thrombectomy

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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.

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