ABSTRACT NUMBER: ESOC2026A1244 EARLY RECURRENT LARGE-VESSEL OCCLUSION REQUIRING REPEAT THROMBECTOMY WITHIN 72 HOURS: EXPERIENCE FROM A PROSPECTIVE THROMBECTOMY NETWORK WITH CONTEXT FROM THE LITERATURE

Abstract Background and aims Early recurrent large-vessel occlusion (LVO) requiring repeat endovascular therapy (EVT) during the same hospitalization is uncommon and poorly described. It is often mixed with re-occlusion or technical failure, limiting insight into its true frequency and short-term outcome. We examined this entity within a strict 72-hour window and summarized how it compares with previously published experience. Methods We reviewed a prospective thrombectomy registry including 781 consecutive EVT cases. Patients undergoing ≥2 thrombectomies within 72 hours were identified. Clinical features, presumed etiology, and early outcomes were described. A focused systematic review of published series reporting repeat EVT for early recurrent LVO was performed to contextualize incidence and etiologic patterns. Results Eleven patients (1.41%) underwent repeat thrombectomy within 72 hours. These events occurred during the same admission. The most frequent underlying mechanism was intracranial atherosclerotic disease, identified in 7 of 11 patients, commonly requiring intracranial stenting or angioplasty. Early neurological outcomes were heterogeneous; despite successful repeat reperfusion. Across published series, repeat EVT is reported at a similar frequency (approximately 1–2%), but the dominant mechanism is most often cardioembolic, typically linked to unstable or delayed anticoagulation. Together, these findings suggest that etiology of recurrence varies by population and vascular substrate, with arterial pathology playing a prominent role in some cohorts. Conclusions Early recurrent LVO requiring repeat thrombectomy within 72 hours affects roughly 1 in 70 EVT patients. Outcomes are variable, and prognosis appears tied to the underlying mechanism. Recognition of this entity and its diverse etiologic drivers informs early surveillance and tailored post-EVT management strategies. Conflict of interest nothing to disclose