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“Incidence and Clinico-Radiological Correlations of Early Arterial Reocclusion After Successful Thrombectomy in Acute Ischemic Stroke”

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Abstract

About half of acute stroke patients treated with mechanical thrombectomy (MT) do not show clinical improvement despite successful recanalization. Early arterial reocclusion (EAR) may be one of the causes that explain this phenomenon. We aimed to analyze the incidence and clinico-radiological correlations of EAR after successful MT. A consecutive series of patients treated with MT between 2010 and 2018 at a single-center included in a prospective registry was retrospectively reviewed. Specific inclusion criteria for the analysis were (1) successful recanalization after MT and (2) availability of pretreatment CT perfusion and follow-up MRI. EAR was evaluated in the follow-up MR angiography. Adjusted regression models were used to analyze the association of EAR with pretreatment variables, infarct growth, final infarct volume, and clinical outcome at 90 days (ordinal distribution of the modified Rankin Scale scores). Out of 831 MT performed, 218 (26%) patients fulfilled inclusion criteria, from whom 13 (6%) suffered EAR. In multivariate analysis controlled by confounders, EAR was independently associated with poor clinical outcome (aOR = 3.2, 95%CI = 1.16–9.72, p = 0.039), greater final infarct volume (aOR = 3.8, 95%CI = 1.93–7.49, p < 0.001), and increased infarct growth (aOR = 8.5, CI95% = 2.04–34.70, p = 0.003). According to mediation analyses, the association between EAR and poor clinical outcome was mainly explained through its effects on final infarct volume and infarct growth. Additionally, EAR was associated with non-cardioembolic etiology (adjusted Odds Ratio (aOR) = 10.1, 95%CI = 1.25–81.35, p = 0.030) and longer procedural time (aOR = 2.6, 95%CI = 1.31–5.40, p = 0.007). Although uncommon, EAR hampers the benefits of successful recanalization after MT resulting in increased infarct growth and larger final lesions.

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Acknowledgment

This work was partially developed at the building Centro Esther Koplowitz, Barcelona, CERCA Programme/Generalitat de Catalunya.

Availability of Data and Material

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Funding

We thank the support of the Spanish Ministry of Economy and Competitiveness for grant to Dr. Sergio Amaro (PI16/00711, funded as part of the Plan Nacional R + D + I and cofinanced by ISCIII-Subdirección General de Evaluación and by the FEDER). Carlos Laredo receives funding from Instituto de Salud Carlos III, with a Predoctoral Grant for Health Research (PFIS, FI16/00231).

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Author notes

  1. Daniel Santana and Carlos Laredo contributed equally to this work.

Authors and Affiliations

  1. Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 170 Villarroel, 08036, Barcelona, Spain

    Daniel Santana, Carlos Laredo, Arturo Renú, Salvatore Rudilosso, Laura Llull, Xabier Urra, Victor Obach, Sergio Amaro & Angel Chamorro

  2. Radiology Department, Hospital Clinic, Barcelona, Spain

    Antonio López-Rueda & Napoleón Macías

Authors
  1. Daniel Santana
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  2. Carlos Laredo
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  3. Arturo Renú
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  4. Salvatore Rudilosso
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  5. Laura Llull
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  6. Xabier Urra
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  7. Victor Obach
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  8. Antonio López-Rueda
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  9. Napoleón Macías
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  10. Sergio Amaro
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  11. Angel Chamorro
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Corresponding authors

Correspondence to Sergio Amaro or Angel Chamorro.

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The authors declare no conflict of interest.

Ethics Approval

The study protocol was approved by the local Clinical Research Ethics Committee under the requirements of Spanish legislation in the field of biomedical research, the protection of personal data (15/1999) and the standards of Good Clinical Practice, as well as with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Given the retrospective nature of the study, the individual consent to participate was not required after the approval from the local Clinical Research Ethics Committee.

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Santana, D., Laredo, C., Renú, A. et al. “Incidence and Clinico-Radiological Correlations of Early Arterial Reocclusion After Successful Thrombectomy in Acute Ischemic Stroke”. Transl. Stroke Res. 11, 1314–1321 (2020). https://doi.org/10.1007/s12975-020-00816-x

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  • DOI: https://doi.org/10.1007/s12975-020-00816-x

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