TY - JOUR 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 DO - 10.1136/jnis-2022-019023 SP - neurintsurg-2022-019023 AU - Ali M Alawieh AU - Reda M Chalhoub AU - Sami Al Kasab AU - Pascal Jabbour AU - Marios-Nikos Psychogios AU - Robert M Starke AU - Adam S Arthur AU - Kyle M Fargen AU - Reade De Leacy AU - Peter Kan AU - Travis M Dumont AU - Ansaar Rai AU - Roberto Javier Crosa AU - Ilko Maier AU - Nitin Goyal AU - Stacey Q Wolfe AU - C Michael Cawley AU - J Mocco AU - Stavropoula I Tjoumakaris AU - Brian M Howard AU - Laurie Dimisko AU - Hassan Saad AU - Christopher S Ogilvy AU - R Webster Crowley AU - Justin R Mascitelli AU - Isabel Fragata AU - Michael R Levitt AU - Joon-tae Kim AU - Min S Park AU - Benjamin Gory AU - Adam J Polifka AU - Charles Matouk AU - Jonathan A Grossberg AU - Alejandro M Spiotta A2 - , Y1 - 2022/08/02 UR - http://jnis.bmj.com/content/early/2022/08/02/jnis-2022-019023.abstract N2 - 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. ER -