TY - JOUR
T1 - The effect of occlusion location and technique in mechanical thrombectomy for minor stroke
AU - Abecassis, Isaac Josh
AU - Almallouhi, Eyad
AU - Chalhoub, Reda M.
AU - Helal, Ahmed
AU - Naidugari, Janki R.
AU - Kasab, Sami Al
AU - Bass, Eric
AU - Ding, Dale
AU - Saini, Vasu
AU - Burks, Joshua D.
AU - Maier, Ilko L.
AU - Jabbour, Pascal
AU - Kim, Joon Tae
AU - Wolfe, Stacey
AU - Rai, Ansaar
AU - Psychogios, Marios Nikos
AU - Samaniego, Edgar
AU - Arthur, Adam S.
AU - Yoshimura, Shinichi
AU - Howard, Brian
AU - Alawieh, Ali
AU - Fragata, Isabel
AU - Cuellar, Hugo
AU - Polifka, Adam
AU - Mascitelli, Justin
AU - Osbun, Joshua
AU - Crosa, Roberto
AU - Matouk, Charles
AU - Park, Min S.
AU - Levitt, Michael R.
AU - Dumont, Travis
AU - Williamson, Richard W.
AU - Spiotta, Alejandro M.
AU - Starke, Robert M.
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2023
Y1 - 2023
N2 - Introduction: Endovascular mechanical thrombectomy (MT) is an established treatment for large vessel occlusion strokes with a National Institutes of Health Stroke Scale (NIHSS) score of 6 or higher. Data pertaining to minor strokes, medium, or distal vessel occlusions, and most effective MT technique is limited and controversial. Methods: A multicenter retrospective study of all patients treated with MT presenting with NIHSS score of 5 or less at 29 comprehensive stroke centers. The cohort was dichotomized based on location of occlusion (proximal vs. distal) and divided based on MT technique (direct aspiration first-pass technique [ADAPT], stent retriever [SR], and primary combined [PC]). Outcomes at discharge and 90 days were compared between proximal and distal occlusion groups, and across MT techniques. Results: The cohort included 759 patients, 34% presented with distal occlusion. Distal occlusions were more likely to present with atrial fibrillation (p = 0.008) and receive IV tPA (p = 0.001). Clinical outcomes at discharge and 90 days were comparable between proximal and distal groups. Compared to SR, patients managed with ADAPT were more likely to have a modified Rankin Scale of 0–2 at discharge and at 90 days (p = 0.024 and p = 0.013). Primary combined compared to ADAPT, prior stroke, multiple passes, older age, and longer procedure time were independently associated with worse clinical outcome, while successful recanalization was positively associated with good clinical outcomes. Conclusions: Proximal and distal occlusions with low NIHSS have comparable outcomes and safety profiles. While all MT techniques have a similar safety profile, ADAPT was associated with better clinical outcomes at discharge and 90 days.
AB - Introduction: Endovascular mechanical thrombectomy (MT) is an established treatment for large vessel occlusion strokes with a National Institutes of Health Stroke Scale (NIHSS) score of 6 or higher. Data pertaining to minor strokes, medium, or distal vessel occlusions, and most effective MT technique is limited and controversial. Methods: A multicenter retrospective study of all patients treated with MT presenting with NIHSS score of 5 or less at 29 comprehensive stroke centers. The cohort was dichotomized based on location of occlusion (proximal vs. distal) and divided based on MT technique (direct aspiration first-pass technique [ADAPT], stent retriever [SR], and primary combined [PC]). Outcomes at discharge and 90 days were compared between proximal and distal occlusion groups, and across MT techniques. Results: The cohort included 759 patients, 34% presented with distal occlusion. Distal occlusions were more likely to present with atrial fibrillation (p = 0.008) and receive IV tPA (p = 0.001). Clinical outcomes at discharge and 90 days were comparable between proximal and distal groups. Compared to SR, patients managed with ADAPT were more likely to have a modified Rankin Scale of 0–2 at discharge and at 90 days (p = 0.024 and p = 0.013). Primary combined compared to ADAPT, prior stroke, multiple passes, older age, and longer procedure time were independently associated with worse clinical outcome, while successful recanalization was positively associated with good clinical outcomes. Conclusions: Proximal and distal occlusions with low NIHSS have comparable outcomes and safety profiles. While all MT techniques have a similar safety profile, ADAPT was associated with better clinical outcomes at discharge and 90 days.
KW - MVO
KW - Thrombectomy
KW - minor stroke
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U2 - 10.1177/15910199231196451
DO - 10.1177/15910199231196451
M3 - Article
C2 - 37593806
AN - SCOPUS:85170252146
SN - 1591-0199
JO - Interventional Neuroradiology
JF - Interventional Neuroradiology
ER -