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SNIS 20th annual meeting oral abstracts
O-014 Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions—insights from STAR
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  1. N Dabhi1,
  2. J Kumar1,
  3. N Ironside1,
  4. R Kellogg1,
  5. I Maier2,
  6. S Al Kasab3,
  7. P Jabbour4,
  8. J Kim5,
  9. S Wolfe6,
  10. A Rai7,
  11. R Starke8,
  12. M Psychogios9,
  13. A Shaban10,
  14. A Arthur11,
  15. S Yoshimura12,
  16. B Howard13,
  17. A Alawieh13,
  18. O Tanweer14,
  19. J Mascitelli15,
  20. I Fragata16,
  21. H Cuellar17,
  22. A Polifka18,
  23. J Osbun19,
  24. R Crosa20,
  25. C Matouk21,
  26. M Levitt22,
  27. W Brinjikji23,
  28. T Dumont24,
  29. R Williamson25,
  30. P Navia26,
  31. A Spiotta3,
  32. M Park1
  1. 1University of Virginia, Charlottesville, VA, USA
  2. 2University Medicine Goettingen, Göttingen, Germany
  3. 3Medical University of South Carolina, Charleston, SC, USA
  4. 4Thomas Jefferson University, Philadelphia, PA, USA
  5. 5Chonnam National University Hospital, Gwangju, Korea, Republic of
  6. 6Wake Forest Baptist Health, Winston-Salem, NC, USA
  7. 7West Virginia University, Morgantown, WV, USA
  8. 8University of Miami Health System, Miami, FL, USA
  9. 9Universitätsspital Basel, Basel, Switzerland
  10. 10University of Iowa, Iowa City, IA, USA
  11. 11University of Tennessee Health Science Center/Semmes Murphey Foundation, Memphis, TN, USA
  12. 12Hyogo College of Medicine, Hyogo, Japan
  13. 13Emory University, Atlanta, GA, USA
  14. 14Baylor College of Medicine, Houston, TX, USA
  15. 15University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
  16. 16Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  17. 17LSU Health Shreveport, Shreveport, LA, USA
  18. 18University of Florida, Gainesville, FL, USA
  19. 19Washington University in St. Louis, St. Louis, MO, USA
  20. 20Médica Uruguaya, Montevideo, Uruguay
  21. 21Yale University, New Haven, CT, USA
  22. 22University of Washington, Seattle, WA, USA
  23. 23Mayo Clinic in Minnesota, Mankato, MN, USA
  24. 24University of Arizona (Banner), Tucson, AZ, USA
  25. 25Alleghany Hospital, Low Moor, VA, USA
  26. 26Hospital Universitario La Paz, Madrid, Spain

Abstract

Background The safety and efficacy of mechanical thrombectomy (MT) for the treatment of acute anterior cerebral artery (ACA) occlusions have not clearly been delineated. In a recent systematic review, MT-treated ACA occlusions were associated with similar rates of successful recanalization, decreased rate of long-term good functional outcome, and increased rate of intracranial hemorrhage (ICH) compared to MT-treated internal cerebral artery (ICA) occlusions. However, procedural and clinical outcomes may differ based on whether the occlusion is isolated to the ACA (ie. primary) or occurs in conjunction with other cerebral arteries (ie. secondary).

Methods We performed a retrospective review of the STAR database. All patients with MT-treated primary and secondary ACA occlusions were included. Baseline characteristics, procedural outcomes, complications, and clinical outcomes were collected. Primary and secondary ACA occlusions were compared using Mann-Whitney U test and Kruskal-Willis test for continuous variables and chi-square test for categorical variables.

Results The study cohort comprised of 270 patients with ACA occlusions (50.7% female, median age 69.4 [56-79]). For ACA occlusions, the overall rate of complications was 9.4%, successful recanalization was 76.3%, poor functional outcome was 76.7%, and 90-day mortality was 38.8%. There were 61 patients with primary ACA occlusion and 209 patients with secondary ACA occlusion. Secondary ACA occlusions had higher rates of distal embolization (30.1% v 14.8%, p=0.04) and intracranial hemorrhage (40.3% v 13.3%, p<0.001). Patients with secondary ACA occlusions also had higher rate of poor functional outcome (ie. mRS 3-6) at 90 days (83.5% v 54.2%, p=0.007). Rate of successful recanalization (73.2% v 77.1%, p=0.7) and mortality at 90 days (33.3% v 40.5%, p=0.7) did not differ between the two groups.

Conclusion Clinical and procedural outcomes for MT-treated ACA occlusions can vary based on etiology (ie. primary, secondary). While rate of successful recanalization and 90-day mortality were similar, secondary ACA occlusions were associated with higher rates of morbidity compared to primary ACA occlusions. Our findings demonstrate the need for an established criteria to determine ideal patient and ACA stroke characteristics amendable to MT treatment. Randomized control trials are necessary to further examine differences in outcomes based on etiology of ACA occlusion.

Disclosures N. Dabhi: None. J. Kumar: None. N. Ironside: None. R. Kellogg: None. I. Maier: None. S. Al Kasab: None. P. Jabbour: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: None. M. Psychogios: None. A. Shaban: None. A. Arthur: None. S. Yoshimura: None. B. Howard: None. A. Alawieh: None. O. Tanweer: None. J. Mascitelli: None. I. Fragata: None. H. Cuellar: None. A. Polifka: None. J. Osbun: None. R. Crosa: None. C. Matouk: None. M. Levitt: None. W. Brinjikji: None. T. Dumont: None. R. Williamson: None. P. Navia: None. A. Spiotta: None. M. Park: None.

https://doi.org/10.1136/jnis-2023-SNIS.14

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