Lack of Reperfusion Rather Than Number of thrombectomy influences postoperative survival in aucte ischemic Stroke patients with large vessel occlusion

Background While a higher number of thrombectomy passes is widely associated with poorer clinical outcomes in acute ischemic stroke with large vessel occlusion (AIS-LVO), its relationship with long-term survival remains uninvestigated. Methods We analyzed a prospective thrombectomy database (March 2016–August 2023). All-cause mortality was assessed over a maximum follow-up of 95 months post-stroke. Multivariable Cox regression evaluated the association between the number of passes and survival time. Kaplan-Meier curves with log-rank tests compared cumulative mortality incidence. Results In patients without successful recanalization, the number of passes did not influence time to mortality. Among successfully recanalized patients, those requiring multiple passes (2, 3, or more) showed a non-significant trend toward higher mortality risk compared to single-pass recanalization. Subgroup analysis revealed a significant interaction in the gender subgroup, suggesting a differential effect of pass number on survival in female patients. Conclusion Despite requiring more attempts, successful recanalization remains beneficial for improving clinical outcomes and extending survival in AIS-LVO patients compared to failed recanalization.