Abstract WP027: Early Recurrent Endovascular Thrombectomy in Patients with Prior Large Vessel Occlusion Treatment

Introduction: Endovascular therapy has been shown to be beneficial in patients with large vessel occlusion (LVO). Rarely, patients will develop a second or recurrent LVO (rLVO) within a short period after their initial LVO. The optimal management for rLVO remains uncertain, but previous studies suggest that repeat endovascular thrombectomy (rEVT) may be a reasonable option. The goal of this study was to determine the rate, etiology, and outcomes of patients who underwent repeat thrombectomy at a thrombectomy capable center. Methods: This is a retrospective cohort study of patients enrolled in an ongoing prospective protocol (NCT00009243) from 01/2018 to 08/2025 and who underwent repeat EVT within 2 weeks of their initial EVT. Descriptive statistics were performed on baseline demographic and clinical information, risk factors, stroke etiology, radiological data, procedural data, post-procedural complications, and clinical outcome. Results: A total of 334 patients underwent EVT from 2018-2025, and 5 (1.5%) patients received a repeat EVT within 2 weeks of their initial EVT. Among patients who received rEVT, the median age was 80 years and 80% were women. Cancer (80%), hypertension (80%), and atrial fibrillation (60%) were the most common vascular risk factors. The median time to rEVT was 33.1 (range 3.0-197) hours. Most occlusions involved the MCA territory (M1 or M2) and 80% of patients had the second occlusion on the contralateral side. A second LVO was detected in 40% (2/5) of patients who underwent post-EVT imaging within 3 hours. Overall, patients with rEVT had a poor outcome with a median mRS at 90 days of 4 (range 3-6). Comparisons between first and second EVT included the following: NIHSS (median) 15 vs. 23; last seen normal to IR suite (median): 173 minutes vs. 90 minutes; number of passes (median) 3 vs. 4; and TICI-3 recanalization: 100% vs 60%. Conclusions: In our population, patients who underwent rEVT were treated faster, but had higher NIHSS scores and lower rates of recanalization. Cancer was common among patients that developed a recurrent LVO. Although the incidence is low, patients who present with rLVO within 2 weeks of an initial LVO should be evaluated for an underlying malignancy as part of their stroke work up.