E-003 delayed reocclusion of recanalized intracranial arteries after mechanical thrombectomy in acute stroke patients

Abstract

Purpose Occlusions of major intracranial vessels are presented with acute infarcts, which can lead to serious morbidity and mortality. Mechanical thrombectomy is an effective revascularization therapy for acute intracranial large vessel occlusion. Results of mechanical thrombectomy are varied according to the studies. Complications including dissection, hemorrhage, reocclusion are also varied. We reviewed the patients of reoccluded intracranial arteries which had initially recanalized by mechanical thrombectomy. Methods We reviewed 180 patients who have undergone Mechanical thrombectomy with Solitaire FR stent from March 2011 to January 2015. We achieved revasculisation (TICI 2,3) in 163 (91%) among 180 patients. But, we experienced delayed reocclusion of recanalized arteries after mechanical thrombectomy in 3 of 163 patients. Results Three patients were found with reocclusion of initially recanalized intracranial arteries with mechanical thrombectomy. Two of whom had occlusion of MCA, and one had occlusion of petrous ICA. We suspect the reasons of reocclusion were the dissection of occluded vessels in one patient and the thrombosis of remained thrombus (TICI2a, 2b) in 2 patients. Initial NIHSS (National Institute of Health Stroke Scale) score were 21, 5 and 15, respectively and NIHSS score at discharge were 17, 4 and 15, respectively. For all 3 patients, TICI grade were 2b, 2b and 2a after the first mechanical thrombectomy. Follow-up Angiogram showed complete reocclusion with TICI grade 0. And Final TICI grade were 2a, 2b and 2b, respectively. All three patients had concomitant PTA with balloon catheter. Conclusions We reviewed these patients and found that delayed reocclusion of recanalized vessels were noted within 24 h after first mechanical thrombectomy. The factors contributed to these results are assumed as TICI grade before and after the first mechanical thrombectomy. But, further evaluation of factors such as NIHSS score, underlying disease, laboratory findings and follow-up angiogram are needed. Also, procedural complications as vasospasm, dissection and hemorrhage should be investigated. Disclosures K. Jang: None. S. Park: None. D. Jang: None. B. Moon: None. Y. Han: None. Y. Park: None.