Successful Mechanical Thrombectomy Research Articles

Mechanical thrombectomy by stent retriever for the treatment of arterial ischemic stroke in a pediatric patient with acute lymphoblastic leukemia: A case report

Introduction: Arterial ischemic stroke (AIS) caused by occlusion of large vessels in childhood is a devastating rare condition that can contribute to long-term disabilities. Childhood leukemia is identified as a recognized risk factor for ischemic strokes. Mechanical thrombectomy is standard of care for large vessel occlusions in adults. However, there are still no definite recommendations regarding application and outcomes of endovascular thrombectomy and the devices used for pediatric patients with arterial ischemic stroke. Case presentation: We report a 13-year-old female with acute lymphoblastic leukemia who developed AIS due to thrombosis in the left internal carotid and proximal middle cerebral artery in the induction phase of treatment. The patient underwent successful mechanical thrombectomy via Solumbra by using “Embolus Retriever with Interlinked Cages (ERIC)” stent retriever and Sofia plus catheter which resulted in successful recanalization of ICA and MCA. Discussion: Selected pediatric patients with AIS due to large vessel occlusions can benefit from mechanical thrombectomy. Although the recently published literature demonstrated the efficacy and safety of MT in children, strong guideline recommendations are still absent. At present, the last AHA/ASA guidelines for early management of AIS recommends intravenous thrombolysis and endovascular therapy in adults, whereas controversy still exists in children. An urgent approach within the defined therapeutic time frame and a multidisciplinary team specialized in pediatric stroke with professional trained interventional neuroradiologist is essential for achieving optimal results. Conclusion: Mechanical thrombectomy provides promising results with high rates of arterial recanalization and favorable outcomes in pediatric patients with AIS.

Transcranial doppler (TCD) in predicting outcomes following successful mechanical thrombectomy of large vessel occlusions in anterior circulation: a systematic review and meta-analysis

BackgroundTranscranial Doppler (TCD) is a non-invasive, bedside tool that allows for real-time monitoring of the patient’s hemodynamic status following mechanical thrombectomy (MT). This systematic review and meta-analysis aims to evaluate...

Angioplasty and/or stenting following successful mechanical thrombectomy for intracranial atherosclerosis-related emergent large vessel occlusive stroke (ASSET): protocol of a multicentre randomised trial

RationaleThe management of residual stenosis after mechanical thrombectomy in patients with intracranial atherosclerotic stenosis-related emerge large vessel occlusive (ICAS-LVO) stroke is still unclear question in clinical practice.AimTo demonstrate the design...

Effect of stroke etiology on treatment-related outcomes in young adults with large vessel occlusion: Results from a retrospective cohort study

IntroductionLarge vessel occlusion-acute ischemic stroke (LVO-AIS) is infrequent in young adults and exhibits distinct stroke mechanisms compared to older adults. This study sought to evaluate the impact of varying stroke etiologies on treatment-related outcomes in young adults with LVO-AIS, an aspect that remains unclear. MethodsThis retrospective cohort study included patients aged 18-50 presenting with AIS from January 2017 to December 2021 within our multi-center stroke network. Patients with LVO on CTA/MRA at presentation were included. We assessed demographics, stroke etiology (TOAST classification), and treatment-related outcomes. Based on intervention received, patients were divided into 5 groups [IV-thrombolysis (IVT) only, Mechanical Thrombectomy (MT) only, IVT+MT, no treatment, unsuccessful MT]. ResultsAmong 1210 AIS patients, 220 with LVO were included. The median age was 42 (36, 46). 75 (34.1 %) patients underwent successful MT (46.7 % received IVT+MT). 26 (11.8 %) received IVT only, 110 (50 %) received neither intervention, and 9 (4.1 %) underwent unsuccessful MT. Per TOAST, 17.4 % had large artery atherosclerosis (LAA), 19.2 % cardio-embolism, 28.6 % stroke of other etiology, and 34.7 % had undetermined etiology. Favorable thrombectomy outcomes (TICI 2b/2c/3) were observed in 87.2 %. Discharge NIH Stroke Scale (NIHSS) scores improved for patients with IVT+MT in all TOAST categories except LAA. ConclusionsYoung adults with LVO-AIS had good outcomes irrespective of stroke etiology, except LAA, which was associated with a higher discharge NIHSS. Moreover, 50 % of young adults in our study received no intervention, a quarter of those owing to delayed presentation. Further studies are needed to identify barriers in seeking acute treatment in young adults with LVO-AIS.

Prospective randomized controlled trial on the safety and neuroprotective efficacy of remote administration of hypothermia over spleen during acute ischemic stroke with mechanical thrombectomy: rationale, design, and protocol.

Brain inflammation plays a key role in ischemia/reperfusion (I/R) injury and is the main cause of "ineffective or futile recanalization" after successful mechanical thrombectomy (MT) in acute ischemic stroke (AIS). One of the primary sources of inflammatory cells after AIS are derived from the spleen. As an innovative and potential neuroprotective strategy after stroke, Remote Administration of Hypothermia (RAH) temporarily suppresses immune activities in the spleen, reduces the release of inflammatory cells and cytokines into blood, and thus reversibly diminishes inflammatory injury in the brain. This single-center, prospective, randomized controlled study (RCT) is proposed for AIS patients with anterior circulation large vessel occlusion (LVO). Subjects will be randomly assigned to either the control or intervention groups in a 1:1 ratio (n = 40). Participants allocated to the intervention group will receive RAH on the abdomen above the spleen prior to recanalization until 6 h after thrombectomy. All enrolled patients will receive standard stroke Guideline care. The main adverse events associated with RAH are focal cold intolerance and abdominal pain. The primary outcome will assess safety as it pertains to RAH application. The secondary outcomes include the efficacy of RAH on spleen, determined by spleen volumes, blood inflammatory factor (cells and cytokines), and on brain injury, determined by infarction volumes and poststroke functional outcomes. This study aims to examine the safety and preliminary effectiveness of RAH over the spleen during endovascular therapy in AIS patients. The results of this study are expected to facilitate larger randomized clinical trials and hopefully prove RAH administration confers adjuvant neuroprotective properties in AIS treated with MT. https://www.chictr.org.cn/. Identifier ChiCTR 2300077052.

Treatment of acute basilar artery occlusion by retrograde puncture via the vertebral artery approach: A care-compliant case report.

Vertebral artery stump syndrome (VASS) is a cause of acute stroke. Owing to the particularity of the pathogenesis of VASS, interventional treatment of VASS is difficult. Common mechanical thrombectomy approaches include femoral and radial artery approaches. However, conventional approaches may not be suitable for VASS. If effective measures are not taken to open offending vessels in time, this can lead to a high rate of disability. In recent years, no consensus has been reached regarding surgical methods for treating VASS. The patient presented to the emergency department with a 2-hour history of disturbance of consciousness. After neurological and magnetic resonance imaging examinations, the patient was diagnosed with acute large vessel occlusive posterior circulation cerebral infarction. The patient's symptoms were not relieved after intravenous infusion of argatroban (10 mg) at a local hospital. We first attempted to open the occluded vertebral artery through normal approaches but failed. We then punctured the vertebral artery, successfully opened the occluded vertebral artery, and performed mechanical thrombectomy. The patient underwent successful vertebral artery puncture and mechanical thrombectomy, with no evidence of postoperative bleeding or vascular injury at the puncture site. The patient regained consciousness the day after surgery but remained impaired in physical activity. After 4 months of rehabilitation, the patient recovered completely. When the conventional approach cannot meet the requirements of mechanical thrombectomy, reverse puncture of the vertebral artery is a feasible surgical method for patients with VASS. However, due to the small number of cases, a series of safety problems such as potential puncture failure, hemorrhage after puncture, and vascular occlusion still need to be further explored.

Dynamic Perviousness: A Novel Imaging Marker for Predicting Mechanical Thrombectomy Outcomes in Acute Ischemic Stroke.

The predictive value of thrombus standard perviousness (SP) in acute ischemic stroke (AIS) for the technical success rates of mechanical thrombectomy (MT) or functional outcomes is not yet conclusive. We investigated the relationship between dynamic perviousness (DP) and revascularization results using time-dependent enhancement curve types determined with computed tomography (CT). A retrospective analysis of 137 AIS patients was performed. DP was calculated as the thrombus attenuation increase (TAI) using three time points and categorized into four groups: (1) no enhancement (CNE); (2) late enhancement (CLE); (3) early enhancement with washout (CW); (4) early enhancement without washout (CNW). Associations with the technical success rate and functional outcomes were assessed. Late enhancement (CLE) had approximately two times higher odds for successful MT as compared to clots with other enhancement dynamics. The odds ratios (logistic regression model with CNW as the reference) for the TICI III scores were 4.04 (p = 0.067), 1.82 (p = 0.3), and 1.69 (p = 0.4) for CLE, CW, and CNE, respectively. The NIHSS scores at discharge and mRS scores at three months showed regression coefficients (linear regression model with CNW as reference) of -3.05 (p = 0.10), -1.17 (p = 0.51), and -1.24 (p = 0.47); and -1.30 (p = 0.097), -0.85 (p = 0.25), and -0.15 (p = 0.83) for CLE, CW, and CNE, respectively. Thrombi with late enhancement patterns showed a higher revascularization rate and better outcomes as compared to clots with early uptake or no washout.

A novel nomogram to predict futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy.

Futile recanalization (FR) is defined as patients with acute ischemic stroke (AIS) due to large vessel occlusion who still exhibits functional dependence although undergoing successful mechanical thrombectomy (MT). We aimed to develop and validate a simple nomogram for predicting the probability of FR after MT treatment in AIS patients. Clinical data of AIS patients in the Jrecan clinical trial in China from March 2018 to June 2019 were collected as the derivation set (n = 162). Meanwhile, clinical data of AIS patients who underwent MT in Baotou Central Hospital and Ningbo No.2 Hospital from 2019 to 2021 were collected as the validation set (n = 170). Multivariate logistic regression analysis was performed for all variables that had p < 0.2 in the univariate analysis in the derivation set. The independent risk factors of FR were further screened out and a nomogram was constructed. The performance of the nomogram was analyzed in the derivation and validation set using C-index, calibration plots, and decision curves. No significant difference in FR rate was detected between the derivation set and the validation set [88/162 (54.32%) and 82/170 (48.23%), p = 0.267]. Multivariate logistic regression analysis showed that age ≥ 65 years old (OR = 2.096, 95%CI 1.024-4.289, p = 0.043), systolic blood pressure (SBP) ≥ 180 mmHg (OR = 5.624, 95%CI 1.141-27.717, p = 0.034), onset to recanalization time (OTR) ≥ 453 min (OR = 2.759, 95%CI 1.323-5.754, p = 0.007), 24 h intracerebral hemorrhage (ICH; OR = 4.029, 95%CI 1.844 ~ 8.803, p < 0.001) were independent risk factors for FR. The C-index of the nomogram of the derivation set and the verification set were 0.739 (95%CI 0.662~0.816) and 0.703 (95%CI 0.621~0.785), respectively. The nomogram composed of age, SBP, OTR, and 24 h ICH can effectively predict the probability of FR after MT in AIS patients.

Recurrent Stroke with Rapid Development of Intracranial Artery Stenosis and Subsequent Successful Mechanical Thrombectomy in Essential Thrombocythemia.

Essential thrombocythemia is a myeloproliferative neoplasm. Ischemic stroke is frequently the first manifestation of essential thrombocythemia. We herein report a patient with JAK2V617 mutation-positive essential thrombocythemia who developed recurrent ischemic stroke with rapid development of intracranial artery stenosis and subsequently underwent successful mechanical thrombectomy. The high JAK2V617F allele burden in our patient (58.4%) may have affected the patient's condition. We discuss similar reports in the literature and the possible pathophysiologic mechanism of large artery involvement in these patients.

Blood Pressure after Successful Endovascular Therapy: A Systematic Review and Meta-Analysis of Randomized Control Trials.

There are limited data evaluating the optimum blood pressure (BP) goal post mechanical thrombectomy (MT) and its effect on outcomes of patients with large vessel occlusions (LVO). The objective of this study was to compare the efficacy and safety of intensive versus conventional BP control after reperfusion with MT via a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched PubMed and Embase to obtain articles related to BP control post MT through September 2023. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 3 months, while secondary outcomes included excellent outcome (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and mortality. Four RCTs with 1,566 patients (762 randomized into intensive BP control vs. 806 randomized into conventional BP control) were included. Analysis showed that there was a lower likelihood of functional independence (mRS 0-2: odds ratio [OR]: 0.68, 95% confidence interval [CI] 0.51-0.91, p = 0.009) in the more intensive treatment group compared with the conventional treatment group. There was no statistically significant difference in achieving excellent outcome (mRS0-1: OR: 0.82, 95% CI: 0.63-1.07; p = 0.15), risk of sICH or mortality. This systematic review and meta- analysis Indicates that in patients who achieved successful MT for acute ischemic stroke with LVO, intensive BP control was associated with a lower likelihood of functional independence at 3 months without significant difference in likelihood of achieving excellent outcome, sICH risk, or mortality. ANN NEUROL 2024;95:858-865.

The Neuroprotective Effect of Therapeutic Hypothermia in Cognitive Impairment of an Ischemia/Reperfusion Injury Mouse Model.

Background and Objectives: Therapeutic hypothermia (TH) shows promise as an approach with neuroprotective effects, capable of reducing secondary brain damage and intracranial pressure following successful mechanical thrombectomy in the acute phase. However, its effect on cognitive impairment remains unclear. This study investigated whether TH can improve cognitive impairment in a mouse model of transient middle cerebral artery occlusion followed by reperfusion (tMCAO/R). Materials and Methods: Nine-week-old C57BL/6N mice (male) were randomly assigned to three groups: sham, tMCAO/R, and tMCAO/R with TH. Cognitive function was assessed 1 month after model induction using the Y-maze test, and regional cerebral glucose metabolism was measured through positron emission tomography with fluorine-18 fluorodeoxyglucose. Results: tMCAO/R induced cognitive impairment, which showed improvement with TH. The TH group exhibited a significant recovery in cerebral glucose metabolism in the thalamus compared to the tMCAO/R group. Conclusions: These findings indicate that TH may hold promise as a therapeutic strategy for alleviating ischemia/reperfusion-induced cognitive impairment.

Abstract TMP89: Thrombus Cellular Composition Predicts Unexpected Early Intracranial Reocclusion After Successful Mechanical Thrombectomy

Introduction: Our objective is to identify thrombus composition and related factors associated with unexpected early intracranial reoclussion ( EIR) after successful mechanical thrombectomy ( MT). Methods: Endovascular treatments of patients with acute intracranial or extracranial stenting were excluded. A total of 206 patients with successful reperfusion ( mTICI ≥ 2b) were included . Each intracranial thrombi obtained by MT were analyzed by Flow Cytometry analysis to provide proportion of main leukocyte composition: granulocytes, monocytes and lymphocyte populations. Thrombi analysis, antithrombotic treatment, etiology , reperfusion treatment features, neuroimaging and other baseline variables were analyzed to identify predictors of early reoclussion in the first 48 hours after thrombectomy . Results: EIT were observed in 5.8 %( 12/206) of successfully reperfused strokes. Patients with EIR were younger [ 67 years ( 47-80) vs. 76 years ( 66-84) ; p = 0.046] with lower basal NIHSS [ 17 ( 10-21) vs. 18 ( 11-21) ; p = 0.022]. Thrombi from patients with EIR had higher proportion of lymphocytes B [1.41 % ( 0.48-2.42) vs. 0.44 %(0.16-1.19) ;p = 0.018] in comparison to cases without reoclussion. Basilar artery occlusion ( BAO) [ 2 (15.4%) vs. 8 (4,3%) ; p 0.081 ] and active smoking [ 4( 30.8%) vs. 24 (12.4%) p =0.062] presented a positive trend with EIR cases . In the logistic regression analysis adjusted by age, previous use of intravenous fibrinolysis, number of endovascular passes , proportion of Lymphocytes B, BAO and active smoking , the independent predictor of early reoclussion was the proportion of Lymphocyte B in intracranial thrombus ( aOR 1.363 , 95% CI 1.060- 1.753). Conclusions: Rich B-Lymphocyte- Thrombus predicts unexpected early intracranial reoclusion after successful mechanical thrombectomy

Abstract WP196: Blood Pressure After Endovascular Therapy: A Systematic Review and Metanalysis of Randomized Control Trials

Background and Objectives: There are limited data evaluating the optimum blood pressure (BP) goal post mechanical thrombectomy (MT) and its effect on outcomes of patients with large vessel occlusions (LVO). The objective of this study was to compare the efficacy and safety of intensive versus less intensive blood pressure control after reperfusion with MT via a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We searched the PubMed, and Embase to obtain articles related to blood pressure control post MT through September, 2023. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 3 months. Effect sizes were computed as odd ratio (OR) with random-effect or fixed-effect models. Results: Four Randomized Clinical Trials (RCTs) with 1566 patients (762 randomized into intensive blood pressure control vs. 806 randomized into loess intensive blood pressure control) were included. The RCT analysis showed that the likehood of functional independence was less in the more intensive treatment group compared with the less intensive treatment group functional independence (mRS 0-2: OR 0.66, 95% CI 0.54-0.89, P &lt; 0.001). There was no significant increasing the risk of symptomatic intracranial hemorrhage (sICH: OR 1.14, 95% CI: 0.77-1.69, P = 0.51), or mortality ( mortality 1.22, 95% CI: 0.90-1.66, P =0.19). Conclusion: This systematic review and meta-analysis indicate that in patients who achieved successful MT for acute ischemic stroke with LVO, intensive BP control was associated with lower likehood of functional independence at 3 months without significant difference in sICH or mortality risk. Results of upcoming RCTs may provide further insight.

Abstract WP180: Novel Machine Learning Model for Prediction of Futile Recanalization in Acute Ischemic Stroke Patients With Anterior Circulation Large Vessel Occlusion

Introduction: Up to 50% of acute ischemic stroke (AIS) patients who undergo successful mechanical thrombectomy (MT) fail to achieve favorable outcomes (futile recanalization). In this study we aim to develop a machine learning (ML) model to predict futile recanalization (FR) in AIS patients who undergo MT. Methods: We used data from an ongoing large, multicenter database from 2013 to 2023. We included AIS patients treated with MT for ICA, M1, or M2 occlusion with successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] score ≥ 2C) and procedure durations under 60 minutes. FR was defined as successful recanalization with 90-day modified Rankin Scale (mRS) 3-6. The dataset was divided into 75% for training and 25% for external validation. Using the Caret Package in R, multiple models were tested, and their performances were evaluated by the area under the curve (AUC) of receiver operating. Both baseline and pre-interventional characteristics were incorporated into the model. The selected model was then externally validated on a 25% validation dataset. Results: Among 2,546 qualified patients, FR occurred in 1,342 (52.7%). In univariate analysis, baseline characteristics were significantly different between FR and non-FR groups. The M5P model demonstrated the highest performance (AUC: 0.833; 95% CI: 0.7989-0.852; PPV: 0.8101) in comparison to other tested models such as logistic regression (AUC: 0.74), RF (AUC: 0.78), J48 (AUC: 0.78), SVM (AUC: 0.79), and GB (AUC: 0.79). The external validation of the model showed satisfactory results (AUC: 75.25; 95% CI: 70-80; PPV: 76.87). Conclusion: Utilizing clinical, pre-procedural, and imaging parameters, the M5P model can efficiently predict F) in AIS patients before attempting MT. This tool can assist neurointerventionalists in adequately choosing their MT candidates.

Glycemic variability after mechanical thrombectomy for anterior circulation acute ischemic stroke.

Morbidity remains high among patients who undergo successful mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO). Stress hyperglycemia worsens the prognosis after acute ischemic stroke (AIS), but aggressively treating hyperglycemia does not improve the outcome. There is no consensus on how to best manage glycemia after AIS. Glycemic variability (GV) reflects glycemic fluctuations over time and could be the culprit. We aimed to elucidate how GV impacts outcome of AIS patients treated with MT. This was a single-center retrospective study. We consecutively included AIS patients who received MT for anterior circulation LVO. We recorded discrete blood glucose measurements within the first 24 hours post thrombectomy, from which we calculated two measures of GV: standard deviation (SD) and coefficient of variation. Univariate and multivariate analyses were conducted to identify predictors of poor functional outcome (modified Ranking scale score 3-6) and mortality at 3-month follow-up. We included 657 patients. Patients with poor functional outcome (42.5%) and patients that died (14.8%) had significantly higher GV as measured by SD. In a multivariable model adjusted for confounders, higher SD was associated with mortality -adjusted odds ratio: 1.020 (95% CI 1.001-1.040)- but not with functional outcome -adjusted odds ratio for modified Ranking scale score 3-6: 1.007 (95% CI 0.990-1.025)-. Our results suggest that higher GV after MT for anterior circulation AIS is an independent risk factor for 3-month mortality. Future trials should evaluate the benefit of reducing GV in this setting.

Pretreatment parameters associated with hemorrhagic transformation among successfully recanalized medium vessel occlusions.

Although pretreatment radiographic biomarkers are well established for hemorrhagic transformation (HT) following successful mechanical thrombectomy (MT) in large vessel occlusion (LVO) strokes, they are yet to be explored for medium vessel occlusion (MeVO) acute ischemic strokes. We aim to investigate pretreatment imaging biomarkers representative of collateral status, namely the hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index, and their association with HT in successfully recanalized MeVOs. A prospectively collected registry of acute ischemic stroke patients with MeVOs successfully recanalized with MT between 2019 and 2023 was retrospectively reviewed. A multivariate logistic regression for HT of any subtype was derived by combining significant univariate predictors into a forward stepwise regression with minimization of Akaike information criterion. Of 60 MeVO patients successfully recanalized with MT, HT occurred in 28.3% of patients. Independent factors for HT included: diabetes mellitus history (p = 0.0005), CBV index (p = 0.0071), and proximal versus distal occlusion location (p = 0.0062). A multivariate model with these factors had strong diagnostic performance for predicting HT (area under curve [AUC] 0.93, p < 0.001). Lower CBV indexes, distal occlusion location, and diabetes history are significantly associated with HT in MeVOs successfully recanalized with MT. Of note, HIR was not found to be significantly associated with HT.

Successful mechanical thrombectomy for terminal ICA bullet embolism: A case report

Bullet embolism after high velocity penetrating trauma is a rare event that can have devastating and wide-ranging effects distant from the original site of injury. A 29-year-old presented with multiple gunshot wounds to the chest, back, abdomen, and lower extremities but no penetrating head injury. After proper resuscitation, the patient was noted to have left-sided hemiparesis and computed tomography angiography of the head showed a bullet fragment that had traveled to the right M1 segment of the middle cerebral artery resulting in occlusion of the vessel. Mechanical thrombectomy was performed in an attempt to remove the bullet fragment but this was unsuccessful as the fragment was firmly lodged in the blood vessel. Aspiration of clot distal to the fragment was then performed in hopes of preventing a large volume ischemic event which was angiographically successful resulting in TICI 2c revascularization. This case demonstrates that thrombectomy can be safely and successfully performed distal to a lodged foreign body.

Robust Collaterals Are Independently Associated With Excellent Recanalization in Patients With Large Vessel Occlusion Causing Acute Ischemic Stroke

Background In patients with acute ischemic stroke secondary to large vessel occlusion, achieving modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 (excellent recanalization) over mTICI 2b is associated with improved functional outcomes. We aimed to determine pretreatment and interventional parameters that are independently associated with mTICI 2c/3 over 2b reperfusion in patients who underwent technically successful mechanical thrombectomy. Methods In this retrospective study, consecutive patients with acute ischemic stroke with anterior circulation large vessel occlusion achieving mTICI 2b/2c/3 recanalization after mechanical thrombectomy were included. We evaluated the association between pretreatment clinical, imaging, and interventional parameters in patients who achieved mTICI 2c/3 versus 2b using multivariate logistic regressions. Results From May 11, 2019 to October 9, 2022, 149 consecutive patients met our inclusion criteria (median 70 years old [interquartile range 65–78.5], 57.7% female). Adjusted multivariate regression analyses showed that patients with excellent recanalization had lower admission National Institutes of Health Stroke Scale scores (adjusted odds ratio [aOR], 0.93; P =0.036), were less likely to have a history of diabetes (aOR, 0.42; P =0.050) and prior stroke (aOR, 0.27; P =0.007), had a cerebral blood volume index ≥0.7 (aOR, 3.75; P =0.007), and were more likely to achieve excellent recanalization with aspiration alone (aOR, 2.89; P =0.012). A multivariate logistic regression model comprising these independent factors predicted mTICI 2c/3 with an area under the curve 0.79 (95% CI, 0.68–0.86; P &lt;0.001), sensitivity of 94%, and specificity of 41%. Conclusion Robust collateral status defined by cerebral blood volume index ≥0.7 on pretreatment computed tomography perfusion, absence of prior stroke, and absence of diabetes are independently associated with excellent recanalization in patients with successfully recanalized acute ischemic stroke‐large vessel occlusion. Our findings highlight the prognostic implications of robust collateral status and modifiable risk factors that may influence collateral status for maximizing the likelihood of excellent recanalization.

Case report: Navigating the challenges: successful mechanical thrombectomy in a case of persistent primitive hypoglossal artery

Case report: Navigating the challenges: successful mechanical thrombectomy in a case of persistent primitive hypoglossal artery

Repeated mechanical thrombectomy in recurrent ischemic stroke due to large vessel occlusion: A case report and literature review

Introduction: Recurrent acute ischemic stroke due to large vessel occlusion is a rare condition that primarily affects patients with cardioembolic risk factors. This condition is more frequent in patients who lack sufficient anticoagulation therapy. Case presentation: We present a case of a 77-year-old woman with paroxysmal atrial fibrillation experienced an acute ischemic stroke due to occlusion of the M2 segment of the left middle cerebral artery. She underwent successful mechanical thrombectomy, leading to revascularization. However, two hours after the procedure, she developed acute left hemiplegia caused by occlusion of the proximal right middle cerebral artery. Another successful mechanical thrombectomy was performed. After a hospital stay of 7 days, the patient was discharged, exhibiting complete regression of the neurological symptoms. Conclusion: Although literature on this subject is limited, available data indicate that repeated mechanical thrombectomy is an effective and safe procedure.