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Ischemic stroke
Original research
Effectiveness and safety of endovascular thrombectomy for large versus medium vessel occlusions: a single-center experience
  1. Kevin Shek1,
  2. Susan Alcock2,
  3. Esseddeeg Ghrooda3,
  4. Anurag Trivedi3,
  5. James McEachern2,
  6. Zul Kaderali4,
  7. Jai Shankar2
  1. 1 Radiology, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
  2. 2 Radiology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
  3. 3 Internal Medicine, Section of Neurology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
  4. 4 Surgery, Section of Neurosurgery, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Jai Shankar, Radiology, University of Manitoba Faculty of Health Sciences, Winnipeg, MB R3E 3P5, Canada; shivajai1{at}gmail.com

Abstract

Background The effectiveness and safety of endovascular thrombectomy (EVT) for medium vessel occlusions (MeVO) in the anterior intracranial circulation for patients with acute ischemic stroke (AIS) has yet to be definitively established. We compared outcomes in patients undergoing EVT for large vessel occlusion (LVO) versus those with MeVO.

Methods This retrospective cohort study, using an intention to treat design, compared the 90-day modified Rankin Scale (mRS) score between 43 patients with MeVO and 199 with LVO in the anterior intracranial circulation. Secondary outcome measures included vessel recanalization using the Thrombolysis in Cerebral Infarction (TICI) score, procedural complications, post-EVT intracranial hemorrhage (ICH), and infarct size.

Results The rate of good functional outcome (90-day mRS 0–2) was higher in patients with LVO than in those with MeVO (32.9% vs 27%), but this was not statistically significant (p=0.19). The rate of EVT procedural complications was also not significantly different between the groups (p=0.10), nor was the rate of ICH (p=0.30). There was also no significant difference in TICI scores between groups (p=0.12). Infarct size was larger in the LVO group (p<0.01). Multivariate analysis showed older age, not receiving recombinant tissue plasminogen activator (r-tPA), and larger infarct size were independent predictors of poor functional outcome at 90 days.

Conclusion The 90-day mRS and rate of periprocedural complications were not significantly different between patients treated for LVO and those treated for MeVO with EVT. Older age, not receiving r-tPA, and larger infarct size were independent predictors of poor outcome at 90 days.

  • CT
  • CT angiography
  • thrombectomy
  • stroke

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data are used in this study and are published in this study and are available from JS. The use of these data would need to be discussed with JS.

https://doi.org/10.1136/neurintsurg-2021-017502

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data are used in this study and are published in this study and are available from JS. The use of these data would need to be discussed with JS.

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    Footnotes

    • Contributors KS and JS were involved in the conception and design, literature search, data acquisition, data analysis, drafting of the initial manuscript, and critical revision for important intellectual content. SA was involved in data acquisition, data analysis, and editing the manuscript. All other authors read and approved the final manuscript.

    • 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 None declared.

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