Background Embolectomy using Stent retriever Assisted Vacuum-locked Extraction (SAVE) is effective in intracranial large vessel occlusion. Which post-bifurcational trunk should be chosen for distal stent retriever placement in M1 occlusions is, however, elusive.
Methods We conducted a retrospective analysis of prospectively collected data from a comprehensive stroke center between 2015 and 2017. Eighty-nine consecutive patients with M1 occlusions were treated with SAVE. Digital subtraction angiography (DSA) series were studied to determine the anatomy of middle cerebral artery division, the position of the stent retriever, and to measure vessel diameters. The primary endpoint was first-pass complete/near-complete reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2c or 3, after distal stent retriever placement in the inferior trunk.
Results In 76/89 (85%) patients, microcatheter series were documented. A microcatheter was placed within the inferior trunk in 30/76 (40%) cases. First-pass near-complete/complete reperfusion was more likely to be achieved when the inferior trunk was used for stent retriever placement rather than the superior trunk (mTICI ≥2c: 22/30 (73%) vs 22/46 (48%), P=0.034; and mTICI 3: 20/30 (67%) vs 17/46 (37%), P=0.018). Median diameter of the inferior trunk was larger than the superior trunk (1.4 mm (IQR 1.26–1.62) vs 1.18 mm (IQR 0.98–1.43), P=0.011). The inferior trunk was dominant in 56/76 (74%) cases. Successful reperfusion was associated with placement within the dominant trunk (33/40 (83%) vs 22/36 (61%), P=0.044).
Conclusion The choice of the inferior trunk for distal stent retriever placement in M1 occlusions is associated with a high rate of first-pass near-complete/complete reperfusion when using SAVE.
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Contributors Conception and design: VM, M-NP. Acquisition of data: AB, IT, SH. Analysis and interpretation of data: VM, AB, M-NP. Drafting the article: VM, M-NP. Critically revising the article: all authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests VM and IT: minor travel grants: Stryker Neurovascular, Kalamazoo, USA. M-NP: minor travel grants and modest speaker’s honoraria: Stryker Neurovascular, Kalamazoo, USA; Phenox, Bochum, Germany; Penumbra, Alameda, USA; Acandis, Pforzheim, Germany; Siemens, Forchheim, Germany.
Ethics approval The study received waived approvals by the local ethics committees of the participating centers. The study was conducted in accordance with the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
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