Thrombectomy Patients Face Higher Stroke Risk After 90 Days, Study Finds
USA: A recent real-world data analysis has highlighted concerns about the long-term outcomes of acute ischemic stroke patients treated with mechanical thrombectomy. While the procedure remains a vital intervention in the acute phase, the study found that risks persist well beyond the initial 90-day recovery period.
"Patients who underwent thrombectomy faced a 25% higher risk of recurrent stroke compared to controls (HR 1.25), with recurrence rates of 63.3% versus 53.1%," the researchers reported in Frontiers in Neurology. "Additionally, their two-year stroke- and palliative care-free survival was notably lower (36.6% vs. 45.8%). Although mortality rates were similar between the groups, palliative care use was slightly less among thrombectomy patients." Key factors influencing these outcomes included age, underlying comorbidities, and procedural complications.
While previous studies have primarily focused on 90-day outcomes in acute ischemic stroke patients treated with thrombectomy, little is known about their long-term prognosis. To address this gap, Adnan I. Qureshi, Zeenat Qureshi Stroke Institutes, Columbia, MO, United States, and colleagues compared extended outcomes—specifically, survival rates and the incidence of recurrent strokes—between patients who underwent thrombectomy and those who did not.
For this purpose, the researchers used Oracle Real-World Data—a large, de-identified dataset of multicenter electronic health records from January 2016 to January 2023—to analyze outcomes in 3,934 acute ischemic stroke patients who underwent thrombectomy and 3,934 matched controls who did not. They assessed the risk of death, palliative care, and new stroke beyond 90 days post-admission using Cox proportional hazards regression to adjust for confounding factors. Kaplan–Meier survival analysis was also employed to estimate stroke- and palliative care-free survival rates.
The study led to the following findings:
- Of the 3,934 acute ischemic stroke patients who underwent thrombectomy, 2,660 either died, received palliative care, or experienced a new stroke during a median follow-up of 775 days.
- The two-year stroke- and palliative care-free survival rate was 36.6% for thrombectomy patients compared to 45.8% for those who did not undergo the procedure (adjusted HR: 1.19).
- The risk of palliative care or death was similar between the two groups (adjusted HR: 0.89).
- Patients who underwent thrombectomy had a higher risk of recurrent stroke compared to controls (adjusted HR: 1.25).
The study found that acute ischemic stroke patients who underwent thrombectomy faced a significantly higher risk of experiencing a new stroke, receiving palliative care, or dying beyond 90 days compared to those who did not receive the procedure. The researchers note that this elevated risk, largely driven by stroke recurrence, highlights the need for long-term monitoring and strengthened preventive strategies to ensure sustained benefits of thrombectomy in this high-risk group.
Reference:
Qureshi, A. I., Baskett, W. I., Bhatti, I. A., Ovbiagele, B., Siddiq, F., Ford, D. E., Gomez, C. R., Hanley, D. F., & Shyu, C. (2025). Post 90-day outcomes of acute ischemic stroke patients following thrombectomy: Analysis of real-world data. Frontiers in Neurology, 16, 1543101. https://doi.org/10.3389/fneur.2025.1543101
