Repeated reperfusion treatment in recurrent ischemic stroke: A retrospective single-center case series

• Published in: Journal of the neurological sciences 2022-03, Vol.434, p.120147-120147, Article 120147
• Main Authors: Dell'Aera, Cristina, Giammello, Fabrizio, Caragliano, Antonio Armando, Ciacciarelli, Antonio, Francalanza, Isabella, Currò, Carmelo Tiberio, Pitrone, Antonio, Grillo, Francesco, Casella, Carmela, Fazio, Maria Carolina, La Spina, Paolino, Cotroneo, Masina, Crea, Pasquale, Toscano, Antonio, Vinci, Sergio Lucio, Musolino, Rosa Fortunata
• Format: Article
• Language: English
• Subjects: Acute ischemic stroke; Brain Ischemia - complications; Brain Ischemia - therapy; Early arterial reocclusion; Endovascular Procedures - methods; Humans; Ischemic Stroke; Large vessel occlusion; Late arterial reocclusion; Repeated reperfusion therapy; Reperfusion; Retrospective Studies; Stroke - etiology; Stroke - therapy; Thrombectomy; Treatment Outcome
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2022.120147

Data regarding repeated reperfusion therapy (rRT) in acute ischemic stroke (AIS), including intravenous thrombolysis and endovascular treatment (EVT), are quite poor. To date, there are only few case reports and five larger studies on repeated EVT. We aimed to report our single-center experience and describe different clinical scenarios of recurrent AIS with emergent large vessel occlusion (LVO), for which the decision-making process could be challenging in the emergency setting. We retrospectively reviewed 765 consecutive AIS patients with LVO, who underwent reperfusion procedures at our comprehensive stroke center, from 2014 to 2020, and identified rRT patients. We identified and reviewed the medical records of eight patients (1.05%), who repeated reperfusive treatment for recurrent stroke within 30 days (early arterial reocclusion, EAR) and after 30 days (late arterial reocclusion, LAR). We assigned collected data to three clinical scenarios, each divided into EAR and LAR cases. All patients had recurrent emergent LVO in the same vessel territory previously affected, both in EAR and LAR patients. A good clinical outcome has been achieved in EAR patients (modified Rankin Score ≤ 2). Artery-to-artery embolic mechanism was more common in the EAR group, while LAR was more frequently associated with cardioembolic source. RRT appears to be an effective treatment option for recurrent LVO, and it should not be withheld in carefully selected patients. EVT should be considered, including aspiration-only and stenting procedures in patients with AIS and recurrent LVO after previous reperfusive treatments, even after a very short time. •Repeated reperfusion therapy (rRT) in recurrent large vessel occlusion (LVO).•Recurrent LVO occurred in the same vessel territory previously affected.•Good clinical outcome achieved in patients with early arterial reocclusion (EAR).•Artery-to-artery embolic mechanism was more common in the EAR.•rRT is an effective option for recurrent LVO in carefully selected patients.