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  • Technical and clinical outcomes in concurrent multivessel occlusions treated with mechanical thrombectomy: insights from the STAR collaboration

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Ischemic stroke
Original research
Technical and clinical outcomes in concurrent multivessel occlusions treated with mechanical thrombectomy: insights from the STAR collaboration
  1. Hassan Saad1,
  2. Sheila Eshraghi1,
  3. Ali M Alawieh1,
  4. Feras Akbik1,
  5. C Michael Cawley1,
  6. Brian M Howard1,2,
  7. Makenna Ash3,
  8. Alice Hsu3,
  9. Aqueel Pabaney1,
  10. Ilko Maier4,
  11. Sami Al Kasab5,
  12. Kareem El Naamani6,
  13. Pascal Jabbour7,
  14. Joon-tae Kim8,
  15. Stacey Q Wolfe9,
  16. Ansaar Rai10,
  17. Robert M Starke11,
  18. Marios-Nikos Psychogios12,
  19. Amir Shaban11,
  20. Adam S Arthur13,
  21. Shinichi Yoshimura14,
  22. Isabel Fragata15,
  23. Hugo H Cuellar-Saenz16,
  24. Adam J Polifka17,
  25. Justin Mascitelli18,
  26. Joshua W Osbun19,
  27. Charles Matouk20,
  28. Min S Park21,
  29. Michael R Levitt22,
  30. Travis M Dumont23,
  31. Richard Williamson24,
  32. Alejandro M Spiotta25,
  33. Jonathan A Grossberg1
  34. On behalf of the STAR Collaborators
  1. 1 Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2 Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3 Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4 Department of Neurology, University Medicine Goettingen, Goettingen, Germany
  5. 5 Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  6. 6 Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
  7. 7 Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  8. 8 Chonnam National University, Gwangju, Korea (the Republic of)
  9. 9 Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
  10. 10 Department of Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
  11. 11 Department of Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
  12. 12 Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
  13. 13 Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  14. 14 Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
  15. 15 Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
  16. 16 Department of Neurosurgery, LSUHSC, Shreveport, Louisiana, USA
  17. 17 Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
  18. 18 Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  19. 19 Department of Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  20. 20 Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
  21. 21 Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
  22. 22 Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
  23. 23 Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
  24. 24 Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
  25. 25 Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Jonathan A Grossberg, Department of Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, GA 30307, USA; jonathan.a.grossberg{at}emory.edu

Abstract

Background Endovascular thrombectomy (EVT) has become the mainstay treatment for large vessel occlusion, with favorable safety and efficacy profile. However, the safety and efficacy of EVT in concurrent multi-territory occlusions (MTVOs) remains unclear.

Objective To investigate the prevalence, clinical and technical outcomes of concurrent EVT for MTVOs.

Methods Data were included from the Stroke Thrombectomy and Aneurysm Registry (STAR) with 32 stroke centers for EVT performed to treat bilateral anterior or concurrent anterior and posterior circulation occlusions between 2017 and 2021. Patients with MTVO were identified, and propensity score matching was used to compare this group with patients with occlusion in a single arterial territory.

Results Of a total of 7723 patients who underwent EVT for acute ischemic stroke, 54 (0.7%) underwent EVT for MTVOs (mean age 69±12.5; female 50%). 28% had bilateral and 72% had anterior and posterior circulations occlusions. The rate of successful recanalization (Thrombolysis in Cerebral Infarction 2b/3), complications, modified Rankin score at 90 days, and mortality was not significantly different between the matched cohorts. Multivariate analysis confirmed that MTVOs were not associated with poor functional outcome, symptomatic intracranial hemorrhage, or longer procedure time.

Conclusion Compared with EVT for single vessel occlusions, EVT in appropriately selected patients with MTVOs has a similar efficacy and safety profile.

  • intervention
  • stroke
  • thrombectomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnis-2022-019608

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @BrianHoward_MD, @PascalJabbourMD, @Starke_neurosurgery, @AdamArthurMD, @DrMichaelLevitt

    • Contributors Conception or design of the work: HS, SE, AA, CMC, BMH, AS, JAG. Data collection: all authors. Data analysis and interpretation: HS, SE, AA, JAG. Drafting the article: HS, SE, AA, JAG. Critical revision of the article: all authors. Final approval of the version to be published: all authors. JAG: Guarantor for the work and the conduct of the study.

    • 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 SAK: Grant funding-Stryker. PJ: Consultant - Balt, Cerus, Microvention, Medtronic. SQW: Board of directors - AANS; associate editor - S:VIN journal. M-NP: Honoraria - Stryker, Medtronic, Penumbra, Acandis, Phenox, Siemens Healthineers; research support - Swiss National Science Foundation, Bangerter-Rhyner Stiftung, Stryker, Phenox, Medtronic, Rapid, Penumbra, Siemens Healthineers. ASA: Consultant for Arsenal, Balt, Johnson and Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, Stryker; research support from Balt, Medtronic, Microvention, Penumbra, and Siemens; shareholder - Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI. AJP: Consultant - Depuy Synthes, Stryker. JM: consultant - Stryker. CM: Consultant-Silk Road, Penumbra, Microvention, Cerevasc, Stryker; speaker-Silk Road, Penumbra. MSP: DSMB-Medtronic. MRL: Educational grant - Stryker, Medtronic; consultant - Medtronic, Aeaean Advisers; travel Support - Penumbra; editorial board, JNIS; stock - Hyperion Surgical, Proprio, Synchron, Cerebrotech, Fluid Biomed, Stereotaxis; advisor - Metis Innovative. AMS: Consultant - Stryker, Penumbra, Terumo, RapidAI. JAG: Grant support- Georgia Research Alliance, Department of Defense, Emory Medical Care Foundation, Neurosurgery Catalyst; Stock - NTI, Cognition. STAR: funded by Penumbra, Medtronic, Stryker.

    • Provenance and peer review Not commissioned; externally peer reviewed.