Abstract 374: Repeat Mechanical Thrombectomy in Short‐Term Large Vessel Re‐occlusion: A Single‐Center Registry Study and Literature Review

Background Stroke is characterized by high incidence, high disability rate, high recurrence rate, and high mortality. Studies have found that stroke patients have a high risk of recurrent stroke within five years of onset, especially within the first two weeks. Shortly after reperfusion therapy for large vessel occlusions (LVO), recurrent large vessel occlusion (rLVO) may occur, potentially leading to worse patient outcomes. There are limited reports in the literature on the frequency and effectiveness of repeat mechanical thrombectomy (MT) in patients with short‐term intracranial large vessel re‐occlusion. Therefore, this article reviews data from our center and conducts a systematic review of the literature. Methods We conducted a retrospective analysis of consecutive acute stroke patients who underwent MT at our hospital between May 2019 and February 2025. Short‐term large vessel re‐occlusion was defined as recurrent large vessel occlusion occurring within 30 days after the first mechanical thrombectomy procedure. Baseline demographic characteristics, stroke etiology, angiographic findings, and clinical outcomes assessed by the modified Rankin Scale (mRS) at 90 days were recorded. Additionally, a systematic review of reported cases of repeat MT performed due to recurrent LVO was conducted. Results Among 772 patients, we identified 3 patients (0.4%) who underwent two mechanical thrombectomy procedures within 30 days due to LVO recurrence. Through the systematic review, 9 papers involving 23,482 patients met the inclusion criteria. A total of 366 patients with short‐term large vessel re‐occlusion were analyzed. The incidence of short‐term large vessel re‐occlusion was found to be approximately 1.6%, with the vast majority of recurrent embolic events occurring within 7 days. The most common etiology of LVO was cardioembolism, accounting for about 39.1% (143/366), followed by large artery atherosclerosis as the second most common cause, accounting for about 14.5% (53/366). The median baseline NIHSS scores were 14 (IQR 8‐21) and 16 (IQR 10‐24) presumably for first and second events, respectively. Successful reperfusion was achieved in 92.5% (135/146) of patients after the first MT and in 90.6% (106/117) of patients after the second MT. The rate of good functional outcome (mRS 0‐2) at 90 days after the second procedure was 62.2% (69/111). Conclusion Although performing repeat mechanical thrombectomy in patients with short‐term recurrent LVO is uncommon, it may be safe and effective. As with the first mechanical thrombectomy, repeat mechanical thrombectomy should be performed again, as this subset of patients may achieve similar good outcomes comparable to the first procedure.