Early reocclusion after endovascular treatment (EVT) for acute ischemic stroke is underrecognized; its determinants and impact remain poorly defined.

Random-effects meta-analysis of early reocclusion after successful EVT (PubMed, Embase, Cochrane Library through January 2026). Crude odds ratios (ORs) were pooled and certainty rated with GRADE. Post hoc sensitivity analyses included only same-site reocclusion definitions.

Ten studies (3,381 patients) were included; 244 (7.2%) reoccluded. Reocclusion was associated with lower 90-day functional independence (OR 0.25, 95% CI 0.17–0.38) and higher mortality (OR 1.86, 1.29–2.68), both moderate certainty. Reocclusion was more frequent with large-artery atherosclerosis (OR 2.24, 1.41–3.55; same-site 3.04, 1.73–5.33) and less frequent with cardioembolism (OR 0.40, 0.28–0.57) and atrial fibrillation (OR 0.39, 0.26–0.59), mutually confounded associations reflecting one embolic-versus-atherothrombotic axis. Prestroke antiplatelet therapy (OR 0.43, 0.28–0.67) lost significance under the same-site definition (0.60, 0.31–1.16). Exploratory data (two cohorts) linked eTICI 2c–3 reperfusion with less reocclusion (OR 0.44, 0.28–0.69). No study reported when etiology was adjudicated; the atherosclerosis association may be partly outcome-induced.

Early reocclusion is uncommon but carries a substantial prognostic penalty. Its determinants appear to lie in the vascular substrate rather than thrombectomy technique; prospective studies with uniform same-site definitions and systematic follow-up imaging are needed.