Abstract
ObjectiveThis study evaluates reocclusion prognostic outcomes and explores reocclusion risk factors after mechanical thrombectomy (MT) in Chinese stroke patients.MethodsAltogether, 614 patients with AIS with successful recanalization after MT were recruited in this study and divided into the reocclusion and the non‐reocclusion group depending on the 24‐h imaging results after MT. Differences between the two groups were compared including 24‐h and 7‐day National Institutes of Health Stroke Scale (NIHSS) scores, 90‐day modified Rankin scale(mRS) scores, good prognosis (mRS:0–2) rates, incidence of intracranial hemorrhage, and 90‐day mortality.ResultsForty‐four (7.2%) patients experienced reocclusion within 24 h. Compared with the non‐reocclusion group, patients in the reocclusion group had higher 24‐h (15 vs. 13) and 7‐day (15 vs. 9) NIHSS scores, 90‐day mRS scores (4 vs. 3), and 90‐day mortality rates (34.1% vs. 18.6%); lower rates of good prognosis (13.6% vs. 9.3%); and a higher incidence of early neurological deterioration (36.4% vs. 14.7%). Age, internal carotid artery occlusion (ICA), intravenous thrombolysis (IVT), number of thrombectomy passes, stent implantation, and levels of D‐dimer (adjusted odds ratio and 95% confidence interval: 0.97, 0.94–0.99; 2.40, 1.10–5.23; 2.21, 1.05–4.66; 2.60, 1.04–6.47; 0.25, 0.09–0.67; and 1.06, 1.01–1.12, respectively) were independently associated with 24‐h reocclusion.InterpretationThe prognosis of reocclusion after MT was poor. Timely evaluation of these factors including age, D‐dimer, ICA occlusion, IVT, number of passes, and stent implantation and appropriate intervention could reduce the incidence of reocclusion for Chinese stroke patients.
Highlights
Recanalization plays a pivotal role in improving the outcomes of patients treated with mechanical thrombectomy (MT) in some instances, it is associated with complications, such as symptomatic intracranial hemorrhage and reocclusion
Inclusion criteria are as follows: age ≥18 years; a National Institutes of Health Stroke Scale (NIHSS) score ≥6; Alberta Stroke Program Early CT (ASPECT) score ≥6; lesion vessel in the internal carotid artery (ICA), middle cerebral artery (MCA) M1 segment, or basilar artery; the time of stroke onset was within 6 h or more than 6 h but computed tomography (CT) perfusion imaging showed obvious penumbra; intracranial hemorrhage was excluded from brain CT findings; patients provided informed consent; patients underwent MT with successful recanalization
Fortyfour of the 614 (7.2%) patients experienced reocclusion within 24 h after MT. These patients were assigned to the reocclusion group; the remaining 570 patients (92.8%) who did not suffer reocclusion were assigned to the nonreocclusion group
Summary
After five high-evidence clinical trials were published in 2015, mechanical thrombectomy (MT) became the recommended strategy for treating acute ischemic stroke (AIS). recanalization plays a pivotal role in improving the outcomes of patients treated with MT in some instances, it is associated with complications, such as symptomatic intracranial hemorrhage (sICH) and reocclusion. Recanalization plays a pivotal role in improving the outcomes of patients treated with MT in some instances, it is associated with complications, such as symptomatic intracranial hemorrhage (sICH) and reocclusion. Research on early reocclusion is rare, the incidence of early symptomatic reocclusion is not lower than that of sICH in stroke patients treated with intravenous thrombolysis (IVT); it is reported to be 14–24% along with the incidence of reocclusion after IVT.. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association.
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