Symptomatic Delayed Reocclusion after Initial Successful Revascularization in Acute Ischemic Stroke

Hussain, Muhammad S.; Lin, Ridwan; Moskowitz, Shaye; Bain, Mark; Gonugunta, Vivekananda; Rasmussen, Peter A.; Masaryk, Thomas J.; Horowitz, Michael B.; Jovin, Tudor; Gupta, Rishi

doi:10.1016/j.jstrokecerebrovasdis.2009.03.002

« Previous Next »Journal of Stroke & Cerebrovascular Diseases
Volume 19, Issue 1 , Pages 36-39, January 2010

Symptomatic Delayed Reocclusion after Initial Successful Revascularization in Acute Ischemic Stroke

Muhammad S. Hussain, MD
- Cerebrovascular Center, Cleveland Clinic Foundation, Ohio
Ridwan Lin, MD
- Stroke Institute, University of Pittsburgh Medical Center, Pennsylvania
Shaye Moskowitz, MD, PhD
- Cerebrovascular Center, Cleveland Clinic Foundation, Ohio
Mark Bain, MD
- Cerebrovascular Center, Cleveland Clinic Foundation, Ohio
Vivekananda Gonugunta, MD
- Cerebrovascular Center, Cleveland Clinic Foundation, Ohio
Peter A. Rasmussen, MD
- Cerebrovascular Center, Cleveland Clinic Foundation, Ohio
Thomas J. Masaryk, MD
- Cerebrovascular Center, Cleveland Clinic Foundation, Ohio
Michael B. Horowitz, MD
- Stroke Institute, University of Pittsburgh Medical Center, Pennsylvania
Tudor Jovin, MD
- Stroke Institute, University of Pittsburgh Medical Center, Pennsylvania
Rishi Gupta, MD
- Cerebrovascular Center, Cleveland Clinic Foundation, Ohio
- Address correspondence to Rishi Gupta, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave, S80, Cleveland, OH 44195.

Received 10 February 2009; accepted 6 March 2009.

Background

Endovascular stroke therapy is used for patients with ischemic stroke after failed intravenous thrombolysis or in patients not eligible for thrombolytics. With increasing experience, acute reocclusion has been described and likely worsens clinical outcomes. We assessed the rates and outcomes of delayed symptomatic reocclusion after endovascular therapy for acute ischemic stroke.

Methods

Patients with acute ischemic stroke undergoing endovascular procedures at out institutions from January 2008 to August 2008 were reviewed. In all, 107 consecutive acute stroke interventions were performed. Four patients (3.5%) experienced delayed symptomatic reocclusion detectable by the National Institutes of Health Stroke Scale (NIHSS).

Results

The 4 patients (age 45-79 years) had baseline NIHSS score ranging from 8 to 24. Three had right middle cerebral artery occlusions and one had a left middle cerebral artery occlusion. Successful recanalization (thrombolysis in myocardial infarction score 2-3) occurred in all cases after initial treatment. All patients improved postprocedure (NIHSS score 5-10). Clinical deterioration (NIHSS score 14-22) occurred 12 to 18 hours postprocedure. Successful recanalization was achieved in each patient, with improvement in NIHSS score (range 6-13) but not to a lower level compared with after the initial intervention.

Conclusions

Delayed symptomatic reocclusion after initial endovascular stroke therapy can lead to sudden clinical deterioration and impact outcomes. The entity may be missed as many patients present with large clinical deficits at presentation thus requiring careful assessments of patients treated via endovascular methods.

Key Words: Acute stroke, thrombolysis, endovascular treatment, reocclusion