RT Journal Article
SR Electronic
T1 Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2022-019023
DO 10.1136/jnis-2022-019023
A1 Ali M Alawieh
A1 Reda M Chalhoub
A1 Sami Al Kasab
A1 Pascal Jabbour
A1 Marios-Nikos Psychogios
A1 Robert M Starke
A1 Adam S Arthur
A1 Kyle M Fargen
A1 Reade De Leacy
A1 Peter Kan
A1 Travis M Dumont
A1 Ansaar Rai
A1 Roberto Javier Crosa
A1 Ilko Maier
A1 Nitin Goyal
A1 Stacey Q Wolfe
A1 C Michael Cawley
A1 J Mocco
A1 Stavropoula I Tjoumakaris
A1 Brian M Howard
A1 Laurie Dimisko
A1 Hassan Saad
A1 Christopher S Ogilvy
A1 R Webster Crowley
A1 Justin R Mascitelli
A1 Isabel Fragata
A1 Michael R Levitt
A1 Joon-tae Kim
A1 Min S Park
A1 Benjamin Gory
A1 Adam J Polifka
A1 Charles Matouk
A1 Jonathan A Grossberg
A1 Alejandro M Spiotta
A1 ,
YR 2022
UL http://jnis.bmj.com/content/early/2022/08/02/jnis-2022-019023.abstract
AB Background Endovascular thrombectomy (EVT) is the standard-of-care for proximal large vessel occlusion (LVO) stroke. Data on technical and clinical outcomes in distal vessel occlusions (DVOs) remain limited.Methods This was a retrospective study of patients undergoing EVT for stroke at 32 international centers. Patients were divided into LVOs (internal carotid artery/M1/vertebrobasilar), medium vessel occlusions (M2/A1/P1) and isolated DVOs (M3/M4/A2/A3/P2/P3) and categorized by thrombectomy technique. Primary outcome was a good functional outcome (modified Rankin Scale ≤2) at 90 days. Secondary outcomes included recanalization, procedure-time, thrombectomy attempts, hemorrhage, and mortality. Multivariate logistic regressions were used to evaluate the impact of technical variables. Propensity score matching was used to compare outcome in patients with DVO treated with aspiration versus stent retrieverResults We included 7477 patients including 213 DVOs. Distal location did not independently predict good functional outcome at 90 days compared with proximal (p=0.467). In distal occlusions, successful recanalization was an independent predictor of good outcome (adjusted odds ratio (aOR) 5.11, p<0.05) irrespective of technique. Younger age, bridging therapy, and lower admission National Institutes of Health Stroke Scale (NIHSS) were also predictors of good outcome. Procedure time ≤1 hour or ≤3 thrombectomy attempts were independent predictors of good outcomes in DVOs irrespective of technique (aOR 4.5 and 2.3, respectively, p<0.05). There were no differences in outcomes in a DVO matched cohort of aspiration versus stent retriever. Rates of hemorrhage and good outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group and attempts in the stent retriever group.Conclusions Outcomes following EVT for DVO are comparable to LVO with similar results between techniques. Techniques may exhibit different futility metrics; stent retriever thrombectomy was influenced by attempts whereas aspiration was more dependent on procedure time.All data relevant to the study are included in the article or uploaded as supplementary information.