TY - JOUR T1 - Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/neurintsurg-2021-017742 SP - neurintsurg-2021-017742 AU - Lukas Meyer AU - Christian Paul Stracke AU - Marta Wallocha AU - Gabriel Broocks AU - Peter B Sporns AU - Eike I Piechowiak AU - Johannes Kaesmacher AU - Christian Maegerlein AU - Franziska Dorn AU - Hanna Zimmermann AU - Weis Naziri AU - Nuran Abdullayev AU - Christoph Kabbasch AU - Daniel Behme AU - Ala Jamous AU - Volker Maus AU - Sebastian Fischer AU - Markus Möhlenbruch AU - Charlotte Sabine Weyland AU - Soenke Langner AU - Dan Meila AU - Milena Miszczuk AU - Eberhard Siebert AU - Stephan Lowens AU - Lars Udo Krause AU - Leonard LL Yeo AU - Benjamin YQ Tan AU - Anil Gopinathan AU - Benjamin Gory AU - Juan F Arenillas AU - Pedro Navia AU - Eytan Raz AU - Maksim Shapiro AU - Fabian Arnberg AU - Kamil Zeleňák AU - Mario Martínez-Galdámez AU - Andreas Kastrup AU - Panagiotis Papanagiotou AU - Andre Kemmling AU - Marios N Psychogios AU - Tommy Andersson AU - René Chapot AU - Jens Fiehler AU - Uta Hanning A2 - , Y1 - 2021/07/15 UR - http://jnis.bmj.com/content/early/2021/07/15/neurintsurg-2021-017742.abstract N2 - Background Whether to approach distal occlusions endovascularly or not in medium-sized vessels secondary to proximal large vessel occlusion stroke remains unanswered.Objective To investigates the technical feasibility and safety of thrombectomy for secondary posterior circulation distal, medium vessel occlusions (DMVO).Methods TOPMOST (Treatment fOr Primary Medium vessel Occlusion STroke) is an international, retrospective, multicenter, observational registry of patients treated for distal cerebral artery occlusions. This study subanalysis endovascularly treated occlusions of the posterior cerebral artery in the P2 and P3 segment secondary preprocedural or periprocedural thrombus migration between January 2014 and June 2020. Technical feasibility was evaluated with the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Procedural safety was assessed by the occurrence of symptomatic intracranial hemorrhage (sICH) and intervention-related serious adverse events.Results Among 71 patients with secondary posterior circulation DMVO who met the inclusion criteria, occlusions were present in 80.3% (57/71) located in the P2 segment and in 19.7% (14/71) in the P3 segment. Periprocedural migration occurred in 54.9% (39/71) and preprocedural migration in 45.1% (32/71) of cases. The first reperfusion attempt led in 38% (27/71) of all cases to mTICI 3. On multivariable logistic regression analysis, increased numbers of reperfusion attempts (adjusted odds ratio (aOR)=0.39, 95% CI 0.29 to 0.88, p=0.009) and preprocedural migration (aOR=4.70, 95% CI,1.35 to 16.35, p=0.015) were significantly associated with mTICI 3. sICH occurred in 2.8% (2/71).Conclusion Thrombectomy for secondary posterior circulation DMVO seems to be safe and technically feasible. Even though thrombi that have migrated preprocedurally may be easier to retract, successful reperfusion can be achieved in the majority of patients with secondary DMVO of the P2 and P3 segment.The data that support the findings of this study are available from the corresponding author after consultation with the participating centers and upon reasonable request. ER -