| Autor: |
Pirson FAV; From the Department of Neurology (F.A.V.P., R.J.v.O., J.S.), Maastricht University Medical Center, the Netherlands., van Oostenbrugge RJ; From the Department of Neurology (F.A.V.P., R.J.v.O., J.S.), Maastricht University Medical Center, the Netherlands., van Zwam WH; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center, the Netherlands., Remmers MJM; Department of Neurology, Amphia Hospital, Breda, the Netherlands (M.J.M.R.)., Dippel DWJ; Department of Neurology (D.W.J.D.), Erasmus MC University Medical Center, Rotterdam, the Netherlands., van Es ACGM; Department of Radiology and Nuclear Medicine (A.C.G.M.v.E.), Erasmus MC University Medical Center, Rotterdam, the Netherlands., van den Wijngaard IR; Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands (I.R.v.d.W.)., Schonewille WJ; Department of Neurology, St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.)., Staals J; From the Department of Neurology (F.A.V.P., R.J.v.O., J.S.), Maastricht University Medical Center, the Netherlands. |
| Abstrakt: |
Background and Purpose- Patients with acute ischemic stroke treated with endovascular thrombectomy may be treated with repeat endovascular thrombectomy (rEVT) in case of recurrent large vessel occlusion. Data on safety and efficacy of these interventions is scarce. Our aim is to report on frequency, timing, and outcome of rEVT in a large nation-wide multicenter registry. Methods- In the Netherlands, all patients with endovascular thrombectomy have been registered since 2002 (MR CLEAN Pretrial registry, MR CLEAN Trial [Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands], and MR CLEAN Registry). We retrospectively reviewed these databases for anterior circulation rEVT cases. Patient characteristics, procedural data, and functional outcome (modified Rankin Scale at 90 days) were analyzed. Results- Of 3928 patients treated between 2002 and 2017, 27 (0.7%) underwent rEVT. Median time between first and second procedure was 78 (1-1122) days; 11/27 patients were re-treated within 30 days. Cardioembolism was the most common etiology (18 patients [67%]). In 19 patients (70%), recurrent occlusion occurred ipsilateral to previous occlusion. At 90 days after rEVT procedure, 44% of the patients had achieved functional independence (modified Rankin Scale score of 0-2), and 33% had died. Adverse events were 2/27 (7.4%) intracranial hemorrhage, 1/27 (3.7%) stroke progression, and 1/27 (3.7%) pneumonia. Conclusions- In this large nationwide cohort of patients with acute ischemic stroke treated with endovascular thrombectomy, rEVT was rare. Stroke cause was mainly cardio-embolic, and most recurrent large vessel occlusions in which rEVT was performed occurred ipsilateral. Although there probably is a selection bias on repeated treatment in case of recurrent large vessel occlusion, rEVT appears safe, with similar outcome as in single-treated cases. |
