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Factors Associated With Early Reocclusion in Recanalized Intracranial Atherosclerotic Occlusion: ANGEL-REBOOT
Lei Li1, Shuang Song1,2, Dapeng Mo1
1Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (L.L., S.S., D.M., X.T., Z.M., F.G.).
Insights
Longer mechanical thrombectomy times increase stroke reocclusion risk. General anesthesia and favorable post-procedure scores reduce this risk in intracranial atherosclerotic occlusion (ICAS-O) patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Early reocclusion after mechanical thrombectomy for intracranial atherosclerotic occlusion (ICAS-O) is linked to poor stroke outcomes.
- Factors influencing early reocclusion in successfully recanalized ICAS-O patients are not fully understood.
- This study analyzes 24-hour reocclusion in a multicenter trial cohort.
Purpose of the Study:
- To identify independent factors associated with early reocclusion after mechanical thrombectomy in ICAS-O patients.
- To investigate the impact of procedural and post-procedural variables on reocclusion.
- To understand predictors of early reocclusion for improved patient management.
Main Methods:
- Post hoc analysis of the ANGEL-REBOOT trial data.
- Inclusion of patients with successfully recanalized ICAS-O.
- Univariable and multivariable logistic regression to identify factors associated with 24-hour reocclusion.
Main Results:
- A total of 299 patients with ICAS-O were analyzed; 9.7% experienced 24-hour reocclusion.
- Increased puncture-to-recanalization time was significantly associated with higher reocclusion risk (OR, 1.80).
- General anesthesia (OR, 0.25) and expanded Thrombolysis in Cerebral Infarction score of 2c-3 (OR, 0.35) were associated with reduced reocclusion.
Conclusions:
- Longer puncture-to-recanalization time is a risk factor for early reocclusion in ICAS-O.
- General anesthesia and favorable post-procedural reperfusion (eTICI 2c-3) are protective against early reocclusion.
- Identifying these factors can help mitigate reocclusion risk and improve clinical outcomes.
Background:
Early reocclusion following successful recanalization through mechanical thrombectomy is linked to poor clinical outcomes in patients with stroke with intracranial atherosclerotic occlusion (ICAS-O). However, the factors influencing early reocclusion remain inadequately understood. This study is a post hoc analysis of 24-hour reocclusion in patients with successfully recanalized ICAS-O from a multicenter trial.
Methods:
Patients with successfully recanalized ICAS-O were selected from the ANGEL-REBOOT trial (Randomized Study of Bailout Intracranial Angioplasty Following Thrombectomy for Acute Large Vessel Occlusion). Reocclusion was defined as a 24-hour arterial occlusive lesion score of 0 to 1, determined by magnetic resonance or computed tomography angiography. Possible factors associated with early reocclusion were screened through univariable analysis, and then, multivariable logistic regression was used to identify independent factors associated with early reocclusion.
Results:
Among the 348 patients in the ANGEL-REBOOT trial, 21 could not be diagnosed with ICAS-O, 14 failed recanalization by the end of the procedure, and 14 had no follow-up angiography data. Finally, a total of 299 subjects were included, with a median age of 63 (interquartile range, 55-69) years, and 77 of 299 (25.75%) were female patients. The 24-hour reocclusion rate was 9.7% (29/299). Through backward elimination, 3 independent factors remained in the final multivariable logistic regression model. Specifically, puncture-to-recanalization time (per hour increase: odds ratio, 1.80 [95% CI, 1.31-2.47]) was positively associated with reocclusion, while general anesthesia (odds ratio, 0.25 [95% CI, 0.10-0.65]) and a postprocedural expanded Thrombolysis in Cerebral Infarction score of 2c-3 (odds ratio, 0.35 [95% CI, 0.14-0.85]) were negatively associated with reocclusion. Compared with patients without reocclusion, those with reocclusion had significantly greater 90-day modified Rankin Scale scores (median 4 versus 1, Mann-Whitney U test; P<0.001).
Conclusions:
In patients with successfully recanalized ICAS-O, a longer puncture-to-recanalization time was associated with an increased risk of early reocclusion, while general anesthesia and a postprocedural expanded Thrombolysis in Cerebral Infarction score of 2c-3 were associated with a reduced risk of early reocclusion.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT05122286.
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