Endovascular thrombectomy(EVT) is the mainstay of treatment of acute ischemic stroke(AIS) with large artery occlusion(LAO). Although recanalization of LAO is the strong predictor of good clinical outcome, it is not well known how many attempts for recanalization it would be advisable. We evaluated the relationship of the number of EVT attempt and clinical outcome.
Methods: Patients who treated with EVT for LAO in anterior circulation and within 24 hours from last seen normal time were included. Patients who needed to the carotid artery stenting during EVT were excluded. The number of EVT attempt counted 1 to 5 or more. Used EVT methods were suction thrombectomy, stent thrombectomy, angioplasty, and chemical thrombolysis.
Results: 207 patients were included. Successful recanalization(mTICI 2b-3) was achieved in 156(75.3%). 78.7% of patients had stent thrombectomy, 31.4% had suction thrombectomy, 21.5% had intracranial angioplasty, and 6.2% had chemical thrombolysis. As the number of EVT attempt increased, the rate of favorable outcome(mRS 0-2) was significantly lowered. Even in case of successful recanalization, the rate of favorable outcome was decreased according to the increase in the number of EVT attempt. Whereas the clinical outcome of patients with 1 to 3 EVT attempt was more favorable than patients without successful recanalization, the clinical outcome of patients with more than 4 EVT attempt was not better.
Conclusions: An increase of number of EVT attempt to achieve successful recanalization is not related to better outcomes. Even if successful recanalization of the LAO in AIS is essential, more than 4 EVT attempt could be futile.
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