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Purpose <p>Reocclusion after endovascular therapy (EVT) may worsen the clinical outcome of patients undergoing EVT for intracranial atherothrombotic stroke with large vessel occlusion (AT-LVO), but the details and risk factors have not been fully investigated.</p> Methods <p>Patients with intracranial AT-LVO were enrolled in a&#xa0;multicenter retrospective registry study conducted at 51&#xa0;centers in Japan and were divided into two groups based on whether reocclusion occurred within 90&#xa0;days after recanalization of intracranial AT-LVO with EVT: the reocclusion group and the patent group. The primary outcome was a&#xa0;modified Rankin Scale score of 0–2 at 90&#xa0;days after EVT. Risk factors for reocclusion were also assessed.</p> Results <p>A&#xa0;total of 461 patients were enrolled, 66 (14.3%) in the reocclusion group and 395 (85.7%) in the patent group. Intracranial stenting and differences in antithrombotic regimens were not associated with reocclusion. The rate of patients with the primary outcome was significantly lower in the reocclusion group than in the patent group (15.4% vs. 46.4%, adjusted odds ratio 0.15 [95% confidence interval 0.06–0.33], <i>P</i> &lt; 0.001). Reocclusion was associated with recurrent ischemic stroke, additional EVT or surgery, symptomatic intracranial hemorrhage, and all-cause death. Direct aspiration and vessel perforation were independent factors for reocclusion (adjusted odds ratio 1.82 [95% confidence interval 1.02–3.25], <i>P</i> = 0.043; adjusted odds ratio 5.91 [95% confidence interval 1.005–35.35], <i>P</i> = 0.049, respectively).</p> Conclusions <p>Reocclusion after EVT was associated with recurrent ischemic stroke, additional EVT or surgery, symptomatic intracranial hemorrhage, and poor clinical outcome at 90&#xa0;days. Direct aspiration and vessel perforation were independent risk factors for reocclusion after EVT.</p>

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Clinical Outcomes and Factors Associated with Reocclusion after Endovascular Therapy for Intracranial Atherothrombotic Stroke with Large Vessel Occlusion

  • 期刊论文

  • 发表日期：

    2025年12月12日

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  • Hiroyuki Ikeda,
  • Kazutaka Uchida,
  • Masanori Kinosada,
  • Minami Uezato,
  • Hiroshi Yamagami,
  • Nobuyuki Sakai,
  • Manabu Shirakawa,
  • Mikiya Beppu,
  • Kazunori Toyoda,
  • Yuji Matsumaru,
  • Yasushi Matsumoto,
  • Kenichi Todo,
  • Mikito Hayakawa,
  • Seigo Shindo,
  • Shinzo Ota,
  • Masafumi Morimoto,
  • Masataka Takeuchi,
  • Hirotoshi Imamura,
  • Kanta Tanaka,
  • Hideyuki Ishihara,
  • Hiroto Kakita,
  • Takanori Sano,
  • Hayato Araki,
  • Tatsufumi Nomura,
  • Fumihiro Sakakibara,
  • Shinichi Yoshimura,
  • Masaki Chin

摘要

Purpose

Reocclusion after endovascular therapy (EVT) may worsen the clinical outcome of patients undergoing EVT for intracranial atherothrombotic stroke with large vessel occlusion (AT-LVO), but the details and risk factors have not been fully investigated.

Methods

Patients with intracranial AT-LVO were enrolled in a multicenter retrospective registry study conducted at 51 centers in Japan and were divided into two groups based on whether reocclusion occurred within 90 days after recanalization of intracranial AT-LVO with EVT: the reocclusion group and the patent group. The primary outcome was a modified Rankin Scale score of 0–2 at 90 days after EVT. Risk factors for reocclusion were also assessed.

Results

A total of 461 patients were enrolled, 66 (14.3%) in the reocclusion group and 395 (85.7%) in the patent group. Intracranial stenting and differences in antithrombotic regimens were not associated with reocclusion. The rate of patients with the primary outcome was significantly lower in the reocclusion group than in the patent group (15.4% vs. 46.4%, adjusted odds ratio 0.15 [95% confidence interval 0.06–0.33], P < 0.001). Reocclusion was associated with recurrent ischemic stroke, additional EVT or surgery, symptomatic intracranial hemorrhage, and all-cause death. Direct aspiration and vessel perforation were independent factors for reocclusion (adjusted odds ratio 1.82 [95% confidence interval 1.02–3.25], P = 0.043; adjusted odds ratio 5.91 [95% confidence interval 1.005–35.35], P = 0.049, respectively).

Conclusions

Reocclusion after EVT was associated with recurrent ischemic stroke, additional EVT or surgery, symptomatic intracranial hemorrhage, and poor clinical outcome at 90 days. Direct aspiration and vessel perforation were independent risk factors for reocclusion after EVT.