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REOCCLUSION WITHIN 24 HOURS AFTER SUCCESSFUL MECHANICAL THROMBECTOMY: ASSOCIATED FACTORS AND LONG-TERM PROGNOSIS

出版	Morressier, 2017
URL	http://books.google.com.hk/books?id=jzG4zQEACAAJ&hl=&source=gbs_api

註釋IntroductionArterial recanalization and early reocclusion after successful recanalization are strong determinants of prognosis in acute ischemic stroke. We assessed associated factors and long-term prognosis of reocclusion after successful mechanical thrombectomy (MT).MethodsPatients from the Acute STroke Registry and Analysis of Lausanne (ASTRAL), from January 2003 to August 2018, treated by successful MT (mTICI 2b-3) and with a 24-hour vascular imaging (computed tomographic or magnetic resonance angiography; window 12-48hours) were included. Reocclusion at this time-point was defined as a new intracranial occlusion within an arterial segment recanalized at the end of MT. Multivariate logistic regression was used to investigate factors associated with reocclusion and its long-term clinical impact. In a 4:1 matched-cohort analysis, presence of residual thrombus/stenosis on final angiographic run post-MT was included as a variable in a second logistic regression for factors associated with reocclusion.ResultsAmong 423 patients with successful recanalization, 28 (6.6%) showed 24-hour reocclusion. Factors independently associated with reocclusion in entire and matched cohorts are displayed in the table below. Residual thrombus/stenosis finding had a positive predictor value for reocclusion of 46.5% (95%CI 36.06%u201357.28%). 24-hour reocclusion was highly associated with unfavourable outcome (adjusted-OR for modified Rankin Scale >2, 5.0; 95%CI 1.2u201320.0). ConclusionAfter successful MT, arterial reocclusion within 24-hours was independently associated with occlusion site, atherosclerotic mechanism, procedural difficulties, and residual thrombus or stenosis on the final angiographic run. Preadmission statin therapy seemed protective. Reocclusion had a major impact on long-term outcome highlighting the need to improve strategies to monitor and prevent it.