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

Hiroyuki Ikeda^{1

2}, Kazutaka Uchida³, Masanori Kinosada⁴, Minami Uezato⁴, Hiroshi Yamagami^{5

6}, Nobuyuki Sakai⁷, Manabu Shirakawa³, Mikiya Beppu³, Kazunori Toyoda⁸, Yuji Matsumaru^{5

9}, Yasushi Matsumoto¹⁰, Kenichi Todo¹¹, Mikito Hayakawa^{5

12}, Seigo Shindo¹³, Shinzo Ota¹⁴, Masafumi Morimoto¹⁵, Masataka Takeuchi¹⁶, Hirotoshi Imamura¹⁷, Kanta Tanaka¹⁸, Hideyuki Ishihara¹⁹, Hiroto Kakita⁷, Takanori Sano²⁰, Hayato Araki²¹, Tatsufumi Nomura²², Fumihiro Sakakibara³, Shinichi Yoshimura³, Masaki Chin⁴

Affiliations

¹ Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan. ikeda930@kuhp.kyoto-u.ac.jp.
² Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, 606-8507, Kyoto, Japan. ikeda930@kuhp.kyoto-u.ac.jp.
³ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
⁴ Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan.
⁵ Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan.
⁶ Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
⁷ Department of Neurosurgery, Seijinkai Shimizu Hospital, Kyoto, Japan.
⁸ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
⁹ Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
¹⁰ Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan.
¹¹ Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan.
¹² Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
¹³ Department of Neurology, Kumamoto University, Kumamoto, Japan.
¹⁴ Oota Tohonya Clinic, Fukuyama, Japan.
¹⁵ Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan.
¹⁶ Department of Neurosurgery, Seisho Hospital, Odawara, Japan.
¹⁷ Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
¹⁸ Stroke Center, Kindai University Hospital, Osakasayama, Japan.
¹⁹ Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan.
²⁰ Department of Neurosurgery, Mie Prefectural General Medical Center, Yokkaichi, Japan.
²¹ Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.
²² Neuroendovasucular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Japan.

PMID: 41388114
DOI: 10.1007/s00062-025-01603-7

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

Hiroyuki Ikeda et al. Clin Neuroradiol. 2025.

. 2025 Dec 12.

doi: 10.1007/s00062-025-01603-7. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan. ikeda930@kuhp.kyoto-u.ac.jp.
² Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, 606-8507, Kyoto, Japan. ikeda930@kuhp.kyoto-u.ac.jp.
³ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
⁴ Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan.
⁵ Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan.
⁶ Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
⁷ Department of Neurosurgery, Seijinkai Shimizu Hospital, Kyoto, Japan.
⁸ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
⁹ Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
¹⁰ Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan.
¹¹ Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan.
¹² Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
¹³ Department of Neurology, Kumamoto University, Kumamoto, Japan.
¹⁴ Oota Tohonya Clinic, Fukuyama, Japan.
¹⁵ Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan.
¹⁶ Department of Neurosurgery, Seisho Hospital, Odawara, Japan.
¹⁷ Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
¹⁸ Stroke Center, Kindai University Hospital, Osakasayama, Japan.
¹⁹ Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan.
²⁰ Department of Neurosurgery, Mie Prefectural General Medical Center, Yokkaichi, Japan.
²¹ Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.
²² Neuroendovasucular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Japan.

PMID: 41388114
DOI: 10.1007/s00062-025-01603-7

Abstract

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.

Keywords: Angioplasty; Aspiration catheter; Atherosclerosis; Recanalization; Stent; Thrombectomy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: H. Ikeda received lecture fees from Medtronic, Daiichi Sankyo, Johnson & Johnson, and Terumo. K. Uchida reports lecturer’s fees from Daiichi Sankyo, Bristol-Myers Squibb, Stryker, and Medtronic. H. Yamagami discloses lecturer’s fees from Stryker, Medtronic, Johnson & Johnson, Daiichi-Sankyo, Otsuka Pharmaceutical, and Bristol-Myers Squibb. N. Sakai reports a research grant from Japan Lifeline, Kaneka, Medtronic, Terumo, and TG Medical, lecturer’s fees from Asahi Intecc, Kaneka, Medtronic, Stryker, and Terumo, membership on the advisory boards for Johnson & Johnson, Medtronic, and Terumo outside the submitted work. M. Shirakawa received lecturer fees from Stryker, Medtronic, Terumo, Johnson & Johnson, and Kaneka. M. Beppu received manuscript fees from Medicus Shuppan. K. Toyoda reports lecture’s fees from Bayer, Daiichi Sankyo, Otsuka, Janssen, and Bristol Myers Squibb. Y. Matsumaru received lecture fees from Medtronic, Stryker, Terumo, Johnson and Johnson, Kaneka, and Jimro. Y. Matsumoto received lecturer fees from Kaneka, Medico’s Hirata, Fuji Systems, GE Healthcare, Otsuka, Takeda, Century Medical, Terumo, Medtronic, and Stryker. K. Todo received lecture fees from Pfizer, Bristol-Myers Squibb, Daiichi Sankyo, Bayer, Stryker, Medtronic, AstraZeneca, Otsuka Pharmaceutical, Kyowa Kirin, Takeda Pharmaceutical, and Amgen. S. Shindo received lecture fees from Medtronic, Kaneka, Stryker, Daiichi Sankyo, Asahi Intecc, Eisai, Bayer, Abbot Medical, Medicos Hirata, and Johnson & Johnson. M. Takeuchi received lecturer fees from Stryker, Daiichi Sankyo, Terumo, Asahi Intecc, and Johnson & Johnson. H. Imamura reports the lecturer’s fees from Medtronic, Daiichi Sankyo., Stryker, Terumo, Johnson & Johnson, and Asahi Intecc. K. Tanaka received lecturer’s fee from Stryker. H. Ishihara received lecture fees from Daiichi Sakyo and Stryker. T. Sano received lecture fees from Stryker. H. Araki received lecture fees from Pfizer, Bristol-Myers Squibb, Daiichi Sankyo, Johnson & Johnson, Medico’s Hirata, Asahi Intecc, and Medtronic. T. Nomura reports lecture’s fee from Oben, Daiici Sankyo, Bayer, Wakamoto Seiyaku, Idorsia Pharma, Stryker, Medtronic, Kaneka, and Johnson & Johnson. F. Sakakibara received manuscript fees from Medicus Shuppan. S. Yoshimura received research grants from Medico’s Hirata, Medtronic, and Terumo and lecture fees from Medtronic, Kaneka, Stryker, Daiichi Sankyo, Bristol Meyers Squibb, and Johnson & Johnson. M. Kinosada, M. Uezato, M. Chin, M. Hayakawa, S. Ota, M. Morimoto, and H. Kakita declare that they have no conflict of interest. Ethical standards: The study protocol was approved by the Institutional Review Board of Hyogo College of Medicine (approval number 3727) and all participating hospitals.

References

1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, et al. Guidelines for the early management of patients with acute Ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute Ischemic stroke: a guideline for Healthcare professionals from the American heart association/American stroke association. Stroke. 2019;50:e344–e418. - DOI - PubMed
1. Yamagami H, Hayakawa M, Inoue M, Iihara K, Ogasawara K, Toyoda K, Hasegawa Y, Ohata K, Shiokawa Y, Nozaki K, et al. Guidelines for mechanical Thrombectomy in Japan, the fourth edition, march 2020: a guideline from the Japan stroke society, the Japan neurosurgical society, and the Japanese society for Neuroendovascular therapy. Neurol Med Chir. 2021;61:163–92. - DOI
1. Yoon W, Kim SK, Park MS, Kim BC, Kang HK. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery. 2015;76:680–6. - DOI - PubMed
1. Baek JH, Kim BM, Kim DJ, Heo JH, Nam HS, Song D, Bang OY. Importance of truncal-type occlusion in stentriever-based thrombectomy for acute stroke. Neurology. 2016;87:1542–50. - DOI - PubMed
1. Suh HI, Hong JM, Lee KS, Han M, Choi JW, Kim JS, Demchuk AM, Lee JS. Imaging predictors for atherosclerosis-related Intracranial large artery occlusions in acute anterior circulation stroke. J Stroke. 2016;18:352–4. - DOI - PubMed - PMC

LinkOut - more resources

Full Text Sources
- Springer

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources