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Updated: Dec 22, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Repeated mechanical thrombectomy in short-term large vessel occlusion recurrence: multicenter study and systematic
Hanna Styczen1, Christian Maegerlein2, Leonard Ll Yeo3
1Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany hanna.styczen@gmx.de.
Background:
Data on the frequency and outcome of repeated mechanical thrombectomy (MT) in patients with short-term re-occlusion of intracranial vessels is limited. Addressing this subject, we report our multicenter experience with a systematic review of the literature.
Methods:
A retrospective analysis was conducted of consecutive acute stroke patients treated with MT repeatedly within 30 days at 10 tertiary care centers between January 2007 and January 2020. Baseline demographics, etiology of stroke, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at 90 days were noted. Additionally, a systematic review of reports with repeated MT due to large vessel occlusion (LVO) recurrence was performed.
Results:
We identified 30 out of 7844 (0.4%) patients who received two thrombectomy procedures within 30 days due to recurrent LVO. Through systematic review, three publications of 28 participants met the criteria for inclusion. Combined, a total of 58 participants were analyzed: cardioembolic events were the most common etiology for the first (65.5%) and second LVO (60.3%), respectively. Median baseline NIHSS (National Institutes of Health Stroke Scale) was 13 (IQR 8-16) before the first MT and 15 (IQR 11-19) before the second MT (p=0.031). Successful reperfusion was achieved in 91.4% after the first MT and in 86.2% patients after the second MT (p=0.377). The rate of functional independence (mRS 0-2) was 46% at 90 days after the second procedure.
Conclusion:
Repeated MT in short-term recurrent LVO is a rarity but appears to be safe and effective. The second thrombectomy should be pursued with the same extensive effort as the first procedure as these patients may achieve similar good outcomes.
Insights
Repeated mechanical thrombectomy (MT) for short-term recurrent large vessel occlusion (LVO) stroke is rare but safe and effective. Patients undergoing a second MT can achieve good functional outcomes, similar to those after the first procedure.
Area of Science:
- Neurology
- Interventional Neurology
- Vascular Neurology
Background:
- Limited data exists on the frequency and outcomes of repeated mechanical thrombectomy (MT) for intracranial vessel re-occlusion.
- This study addresses the knowledge gap by reporting multicenter experience and a systematic literature review.
Purpose of the Study:
- To evaluate the safety and efficacy of repeated MT in acute stroke patients with short-term re-occlusion.
- To determine the outcomes of patients requiring a second MT procedure within 30 days.
Main Methods:
- Retrospective analysis of acute stroke patients undergoing repeated MT within 30 days at 10 centers (2007-2020).
- Systematic review of literature for studies reporting repeated MT due to large vessel occlusion (LVO) recurrence.
- Evaluation of baseline demographics, stroke etiology, angiographic success, and 90-day functional outcomes (modified Rankin Scale).
Main Results:
- Identified 30 patients (0.4%) requiring repeated MT within 30 days; systematic review added 28 participants.
- Cardioembolic events were the most common etiology for both first and second LVO (65.5% and 60.3%).
- Successful reperfusion rates were high after both first (91.4%) and second MT (86.2%); 46% achieved functional independence (mRS 0-2) at 90 days.
Conclusions:
- Repeated MT for short-term recurrent LVO is infrequent but demonstrates safety and effectiveness.
- The second thrombectomy procedure should be performed with the same diligence as the first, as comparable outcomes are achievable.
