Effectiveness and safety of endovascular thrombectomy for large versus medium vessel occlusions: a single-center experience

Shek, Kevin; Alcock, Susan; Ghrooda, Esseddeeg; Trivedi, Anurag; McEachern, James; Kaderali, Zul; Shankar, Jai

doi:10.1136/neurintsurg-2021-017502

Cited by 10 publications

(6 citation statements)

References 23 publications

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“…A recently published article demonstrated that in AIS patients, a larger 24-hour post-reperfusion infarct size was an independent predictor of poor functional outcome (49). Our study showed that WUS patients who underwent EVT had lower 24-hour post-reperfusion infarct volume.…”

Section: Discussionsupporting

confidence: 63%

Multimodal CT imaging characteristics may predict post-reperfusion infarct volume in wake-up stroke patients

Sha¹,

Fan²,

Zhang³

et al. 2023

Quant Imaging Med Surg

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Background: Accurate prediction of subsequent infarct volume in acute ischemic stroke (AIS) patients helps determine appropriate interventions and prognosis. The objectives are to assess whether early multimodal CT imaging characteristics of wake-up stroke (WUS) patients could predict post-reperfusion infarct volume and evaluate the accuracy of baseline infarct and penumbra volumes for predicting follow-up infarct volume.Methods: This retrospective study included WUS patients, last seen well (LSW) >6 hours, with multimodal CT imaging at baseline. Baseline non-contrast CT (NCCT) and CT perfusion were analyzed using RAPID software, and CT angiography using maximum intensity projection. Post-reperfusion infarct volume was assessed at 24-hour following reperfusion on magnetic resonance diffusion-weighted imaging (DWI).Patients were stratified by treatment module for analyses.Results: Of 34 eligible patients, 9 (26.5%) received intravenous recombinant tissue plasminogen activator (r-tPA) alone and 25 (73.5%) received both endovascular thrombectomy (EVT) and r-tPA. All patients had a strong correlation between baseline NCCT alberta stroke program early CT score, clot burden score (CBS), Tan score, infarct volume, penumbra volume with 24-hour post-reperfusion infarct volume (respectively, r=0.172, P=0.015; r=0.118, P=0.047; r=0.149, P=0.024; r=0.311, P=0.001 and r=0.120; P=0.045). Among reperfusion therapies, WUS patients who received EVT had a significantly lower 24-hour post-reperfusion infarct volume and had a significant difference between baseline infarct volume and 24-hour post-reperfusion infarct volume (respectively, 82 vs. 14, P=0.032 and 47 vs. 14, P=0.04).Conclusions: Primarily obtained multimodal CT imaging characteristics may predict post-reperfusion infarct volume in WUS patients, and those who underwent EVT had a significantly lower post-reperfusion infarct volume.

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Section: Discussionsupporting

confidence: 63%

Multimodal CT imaging characteristics may predict post-reperfusion infarct volume in wake-up stroke patients

Sha¹,

Fan²,

Zhang³

et al. 2023

Quant Imaging Med Surg

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“…In fact, more than two attempts was an independent predictor of poor outcome at 90 days compared with three or more attempts, indicating that a lower number of thrombectomy attempts is tolerated in DVO compared with LVO. Notably, successful recanalization in this cohort was an independent predictor of good outcome in the DVO group; however, there was no correlation between the recanalization score (2B, 2C, vs 3) and clinical outcomes 26…”

Section: Discussionmentioning

confidence: 53%

Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique

Alawieh

Chalhoub

Kasab

et al. 2022

J NeuroIntervent Surg

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BackgroundEndovascular 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.MethodsThis 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 retrieverResultsWe 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.ConclusionsOutcomes 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.

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“…The efficacy and safety of EVT for MeVO have been studied extensively, with most publications being retrospective and single-centre studies. [5][6][7][8][9][10][11][12][13] Thus, their findings might not be sufficiently applicable to real-world practice. As a result, a multicentre study is required to explore whether MeVO could benefit from EVT.…”

Section: What This Study Addsmentioning

confidence: 99%

“…The efficacy and safety of EVT for MeVO have been studied extensively, with most publications being retrospective and single-centre studies 5–13. Thus, their findings might not be sufficiently applicable to real-world practice.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment for acute ischaemic stroke due to medium vessel occlusion: data from ANGEL-ACT registry

et al. 2022

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ObjectivesTo investigate the safety and efficacy of endovascular treatment (EVT) for acute medium vessel occlusion (MeVO) in the anterior circulation and to explore the independent predictors of the 90-day good outcome for such patients.MethodsData from ANGEL-ACT Registry were analysed in our study. The outcomes, such as the modified Rankin Scale (mRS) at 90 days, successful recanalisation rate and symptomatic intracranial haemorrhage (SICH) rate, were compared between MeVO and acute large vessel occlusions (LVO). Then, the independent predictors of the good outcome at 90 days in MeVO patients were determined by the logistic regression analyses.ResultsWe included 1032 subjects in the analysis, of which, 147 were MeVO and 885 were LVO. mRS at 90 days distribution (3 (0–4) vs 3 (0–5), common odds ratio (OR) =1.00, 95% confidence interval (CI) 0.73 to 1.38, p=0.994), SICH rate (4.8% vs 8.9%; OR=0.59, 95% CI 0.26 to 1.34, p=0.205) and successful recanalisation rate (89.8% vs 89.7%; OR=1.00 95% CI 0.51 to 1.93, p=0.992) were similar between the MeVO and LVO groups after adjusting for the confounders. We identified that baseline neutrophil-to-lymphocyte ratio ≤4.1 (OR=2.13, 95% CI 1.14 to 3.99, p=0.019), baseline National Institutes of Health Stroke Scale ≤14 (OR=1.96, 95% CI 1.02 to 3.80, p=0.045) and mechanical thrombectomy passes ≤1 (OR=2.16, 95% CI 1.14 to 4.11, p=0.021) were independent predictors of the 90-day good outcome in MeVO patients undergoing EVT.ConclusionsPatients with MeVO achieved similar 90-day mRS, SICH rate and successful recanalisation rate after EVT compared with patients with LVO. Several independent predictors of 90-day good outcome in MeVO patients undergoing EVT were determined, which should be highly considered in MeVO stroke management.

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Effectiveness and safety of endovascular thrombectomy for large versus medium vessel occlusions: a single-center experience

Cited by 10 publications

References 23 publications

Multimodal CT imaging characteristics may predict post-reperfusion infarct volume in wake-up stroke patients

Multimodal CT imaging characteristics may predict post-reperfusion infarct volume in wake-up stroke patients

Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique

Endovascular treatment for acute ischaemic stroke due to medium vessel occlusion: data from ANGEL-ACT registry

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