Background The safety and efficacy of mechanical thrombectomy (MT) for the treatment of acute anterior cerebral artery (ACA) occlusions have not clearly been delineated. Outcomes may be impacted based on whether the occlusion is isolated to the ACA (primary ACA occlusion) or occurs in conjunction with other cerebral arteries (secondary).
Methods We performed a retrospective review of the multicenter Stroke Thrombectomy and Aneurysm (STAR) database. All patients with MT-treated primary or secondary ACA occlusions were included. Baseline characteristics, procedural outcomes, complications, and clinical outcomes were collected. Primary and secondary ACA occlusions were compared using the Mann–Whitney U test and Kruskal–Willis test for continuous variables and the χ2 test for categorical variables.
Results The study cohort comprised 238 patients with ACA occlusions (49.2% female, median (SD) age 65.6 (16.7) years). The overall rate of successful recanalization was 75%, 90-day good functional outcome was 23%, and 90-day mortality was 35%. There were 44 patients with a primary ACA occlusion and 194 patients with a secondary ACA occlusion. When adjusted for baseline variables, the rates of successful recanalization (68% vs 76%, P=0.27), 90-day good functional outcome (41% vs 19%, P=0.38), and mortality at 90 days (25% vs 38%, P=0.12) did not differ between primary and secondary ACA occlusion groups.
Conclusion Clinical and procedural outcomes are similar between MT-treated primary and secondary ACA occlusions for select patients. Our findings demonstrate the need for established criteria to determine ideal patient and ACA stroke characteristics amenable to MT treatment.
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.
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Contributors Conception and design: ND, MSP, JSK, RTK, AMS. Acquisition, analysis, or interpretation of data: M-MS, KU. Drafting of the manuscript: ND, JSK, NI, MSP, RTK. Critical revision of the manuscript for important intellectual content: ND, JSK, NI, RTK, IM, SAK, PJ, J-TK, SQW, AR, RMS, M-NP, EAS, ASA, SY, HC, BMH, AA, DGR, OT, JM, IF, AJP, JWO, RJC, CM, MRL, WB, MM, TMD, RW, PN, PK, RDL, SAC, ME, AMS, MSP. Statistical analysis: M-MS, KU. Obtained funding: AMS. Administrative, technical, or material support: AMS. Supervision: MSP, AMS.
Guarantor: MSP, AMS
Funding STAR receives financial support from Medtronic, Stryker Neurovascular, Penumbra, RapidAI, and Avail for maintenance of research database.
Competing interests KU receives lecture fees from Daiichi-Sankyo, Bristol-Myers Squibb, Stryker, and Medtronic. SY receives lecture fees from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. IM has speaker's honoraria from Pfizer and Bristol-Myers Squibb. SAK has a grant from Stryker for RESCUE-ICAS registry. RMS has research supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of Health, an unrestricted research grant from Medtronic and Balt, and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M-NP has grants from the Swiss National Science Foundation (SNF), Bangerter-Rhyner Stiftung, Stryker Neurovascular, Phenox, Penumbra, and Rapid Medical, Sponsor-PI SPINNERS trial for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), research agreements with Siemens Healthineers, and has speaker fees from Stryker Neurovascular, Medtronic, Penumbra, Acandis, Phenox, Siemens Healthineers. EAS is a consultant for Medtronic, Microvention, Rapid Medical. ASA is a consultant for Arsenal, Balt, Johnson & Johnson, Medtronic, Microvention, Penumbra, Perfuze, Scientia, Siemens, Stryker; research support from Balt, Medtronic, Microvention, Penumbra and Siemens; shareholder Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Perfuze, Revbio, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI. SY has a lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. HC is a consultant for Medtronic, Penumbra and Microvention. DGR is a consultant for Penumbra, Balt, Microvention, Phenox. OT has consulting agreements with Viz.AI, Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. Proctor: Microvention, Medtronic; educational/research grants: Q’apel, Steinberg Foundation. CM is a consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical; speaker for Penumbra and Silk Road Medical. MSP is a consultant for Medtronic. MRL has unrestricted educational grants from Medtronic and Stryker, consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative, equity interest in Proprio, Cerebrotech, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical, and makes up the editorial boards of Journal of NeuroInterventional Surgery and Frontiers in Surgery. RW is a consultant for Medtronic, Stryker, and Synaptive Medical. PN is a consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. PK has grants from the NIH (1U18EB029353-01) and unrestricted educational grants from Medtronic and Siemens, is a consultant for Imperative Care and Stryker Neurovascular, and has stock ownership in Vena Medical. RDL is a PI for Imperative Trial, has research grants from Siemens Healthineers and Kaneka Medical, is a consultant for Cerenovus, Stryker Neurovascular and Scientia Vascular, and has minor equity interest in Vastrax, Borvo Medical, Synchron, Endostream, Von Vascular. SAC is a consultant and proctor for Medtronic and Microvention. AMS has research support from Penumbra, Stryker, Medtronic, RapidAI, Avail, is a consultant for Penumbra, Stryker, Terumo, and RapidAI, and has equity in Avail.
Provenance and peer review Not commissioned; externally peer reviewed.
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