Abstract
Introduction: Endovascular Therapy (EVT) has demonstrated significant benefits for selected acute ischemic stroke (AIS) with emergent large vessels occlusion (ELVO). Early recanalization is one of the most significant predictors of favorable outcome. However, re-occlusion during the procedure remains a challenge and may prolong the time needed for recanalization in a subset of patients. We planned to explore the clinical, radiographic and laboratory features that are associated with intra-procedural re-occlusion. Method: We retrospectively reviewed consecutive patients who received EVT for ELVO in a single academic health system. Re-occlusion was defined if the occluded target vessel recanalized with TICI ≥2, but became TICI<2 on repeated diagnostic angiography. T test/Wilcoxon test and Chi-square were used to compare risks factors, atherosclerotic plaque burden, and coagulation profile (obtained prior to procedure) between patients with and without re-occlusion. Results: Among 265 patients (male 46.4%, mean age 69 ±14.4 year old), 25 patients had re-occlusion intra-operatively. The history of cardiovascular risks factors (HTN, HLD, DM, smoking, atrial fibrillation), prior use of antiplatelets or antithrombotics, the number of cerebral arteries with atherosclerotic lesions, and the level of platelets, PT, PTT, INR, LDL and HbA1c were similar between patients with and without re-occlusion. Compared to patients without re-occlusion, those with re-occlusion had a higher proportion of stroke with the etiology of large artery atherosclerosis (34.8% vs 3.2%, p<0.001), and tended to have a longer time from last know well to groin puncture (498 ± 411 vs 408±328 minutes, p=0.15). Conclusion: Large artery atherosclerotic disease was a more common stroke etiology in patients with re-occlusion during thrombectomy for ELVO. Underlying vasculopathy and plaque rupture may have precipitated the thrombotic process.
Published Version
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