Mechanical thrombectomy in patients with recurrent stroke: a cohort study based on individual patient data pooled from four prospective multicenter studies

Background: Despite advancements in mechanical thrombectomy (MT), stroke continues to be a major global burden. While outcomes for first-time stroke patients have been extensively studied, evidence remains limited for those with recurrent strokes. Materials and methods: This study utilized pooled data from three clinical trials and one prospective registry, including a total of 3516 patients with ischemic stroke who underwent MT within 24 hours of symptom onset. Patients were stratified based on the presence ( n = 617) or absence ( n = 2899) of a history of ischemic and/or hemorrhagic stroke. The primary efficacy outcome measure was an excellent functional outcome, defined as a 90-day modified Rankin scale (mRS) of 0 or 1 or no disability accumulation. This outcome was analyzed using binary logistic regression, adjusting for prespecified prognostic variables, and reported as an odds ratio (OR). The main secondary efficacy outcome was disability accumulation, assessed by the shift in mRS (ranging from −2 to 6) at 90 days in relation to baseline mRS; Results: A total of 3516 patients [of whom 2127 were men (60.5%); median (interquartile] age, 68 (58–75) years] were recruited into the study. Of these, 617 patients had a history of stroke, whereas 2899 had no such history. Patients with a history of stroke had a lower proportion of excellent functional outcome defined as 90-day mRS of 0 or 1 or no accumulation of disability [adjusted OR, 0.71 (95% CI, 0.61–0.96); P = 0.02]. However, there was comparable in shift of mRS [adjusted OR, 0.90 (95% CI, 0.69–1.16); P = 0.41] between the two groups. Conclusions: Among patients who received MT, a history of stroke was associated with worse functional outcomes.