RT Journal Article SR Electronic T1 Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP neurintsurg-2021-017742 DO 10.1136/neurintsurg-2021-017742 A1 Lukas Meyer A1 Christian Paul Stracke A1 Marta Wallocha A1 Gabriel Broocks A1 Peter B Sporns A1 Eike I Piechowiak A1 Johannes Kaesmacher A1 Christian Maegerlein A1 Franziska Dorn A1 Hanna Zimmermann A1 Weis Naziri A1 Nuran Abdullayev A1 Christoph Kabbasch A1 Daniel Behme A1 Ala Jamous A1 Volker Maus A1 Sebastian Fischer A1 Markus Möhlenbruch A1 Charlotte Sabine Weyland A1 Soenke Langner A1 Dan Meila A1 Milena Miszczuk A1 Eberhard Siebert A1 Stephan Lowens A1 Lars Udo Krause A1 Leonard LL Yeo A1 Benjamin YQ Tan A1 Anil Gopinathan A1 Benjamin Gory A1 Juan F Arenillas A1 Pedro Navia A1 Eytan Raz A1 Maksim Shapiro A1 Fabian Arnberg A1 Kamil Zeleňák A1 Mario Martínez-Galdámez A1 Andreas Kastrup A1 Panagiotis Papanagiotou A1 Andre Kemmling A1 Marios N Psychogios A1 Tommy Andersson A1 René Chapot A1 Jens Fiehler A1 Uta Hanning A1 , YR 2021 UL http://jnis.bmj.com/content/early/2021/07/15/neurintsurg-2021-017742.abstract AB 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.