Mohammad Anadani1, Ali Alawieh2, Reda Chalhoub1, Pascal Jabbour3, Robert M Starke4, Adam Arthur5, Nitin Goyal5, Stacey Wolfe6, Kyle M Fargen6, Jonathan A Grossberg7, Brian M Howard7, Reade De Leacy8, Christopher Kellner8, Peter Kan9, Travis Dumont10, Ansaar Rai11, Joshua Osbun12, Roberto Crosa13, Ilko Maier14, Fábio A Nascimento15, Min S Park16, Michael R Levitt17, Isabel Fragata18, Charles Matouk19, R Webster Crowley20, Shakeel A Chowdhry21, Christopher Ogilvy22, Maxim Mokin23, Justin Mascitelli24, Albert J Yoo25, Richard W Williamson26, Sharon Webb27, Marios-Nikos Psychogios28, Sami Al Kasab1, Alejandro M Spiotta29. 1. Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA. 2. Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Neurosurgery, Emory University, Atlanta, Georgia, USA. 3. Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. 4. Department of Neurosurgery and Radiology, University of Miami, Miller School of Medicine, Miami, Florida, USA. 5. Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey Clinic, Memphis, Tennessee, USA. 6. Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA. 7. Department of Neurosurgery, Emory University, Atlanta, Georgia, USA. 8. Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA. 9. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA. 10. Department of Neurosurgery, Banner University of Arizona Medical Center, Tucson, Arizona, USA. 11. Department of Radiology, West Virginia University, Morgantown, West Virginia, USA. 12. Department of Neurosurgery, Washington University, St. Louis, Missouri, USA. 13. Centro Endovascular Neurológico, Médica Uruguaya, Montevideo, Uruguay. 14. Department of Neurology, University Medical Center Göttingen, Germany. 15. Department of Neurology, Baylor College of Medicine, Houston, Texas, USA. 16. Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. 17. Department of Neurosurgery, University of Washington, Seattle, Washington, USA. 18. Department of Neurosurgery, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal. 19. Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA. 20. Department of Neurosurgery, Rush University, Chicago, Illinois, USA. 21. Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA. 22. Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 23. Department of Neurosurgery, University of South Florida, Tampa, Florida, USA. 24. Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. 25. Texas Stroke Institute, Dallas-Fort Worth, Texas, USA. 26. Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. 27. Department of Neurosurgery, Bon Secours Medical Center, Greenville, South Carolina, USA. 28. Department of Neuroradiology, University Hospital Basel, Basel, Switzerland. 29. Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA. Electronic address: spiotta@musc.edu.
Abstract
BACKGROUND: Mechanical thrombectomy (MT) is the standard of care for the treatment of proximal anterior circulation large vessel occlusions. However, little is known about its efficacy and safety in the treatment of distal intracranial occlusions. METHODS: This is a multicenter retrospective study of patients treated with MT at 15 comprehensive centers between January 2015 and December 2018. The study cohort was divided into 2 groups based on the location of occlusion (proximal vs. distal). Distal occlusion was defined as occlusion of M3 segment of the middle cerebral artery, any segment of the anterior cerebral artery, or any segment of the posterior cerebral artery. Only isolated distal occlusion was included. Good outcome was defined as 90-day modified Rankin scale score 0-2. RESULTS: A total of 4710 patients were included in this study, of whom 189 (4%) had MT for distal occlusions. Compared with the proximal occlusion group, distal occlusion group had a higher rate of good outcome (45% vs. 36%; P = 0.03) and a lower rate of successful reperfusion (78% vs. 84%; P = 0.04). However, the differences did not retain significance in adjusted models. Otherwise there was no difference in the rate of hemorrhagic complications, mortality, or procedure-related complications between the 2 groups. Successful reperfusion, age, and admission stroke severity emerged as predictors of good functional outcome in the distal occlusion group. CONCLUSIONS: Thrombectomies of distal vessels achieve high rate of successful reperfusion with similar safety profile to those in more proximal locations.
BACKGROUND: Mechanical thrombectomy (MT) is the standard of care for the treatment of proximal anterior circulation large vessel occlusions. However, little is known about its efficacy and safety in the treatment of distal intracranial occlusions. METHODS: This is a multicenter retrospective study of patients treated with MT at 15 comprehensive centers between January 2015 and December 2018. The study cohort was divided into 2 groups based on the location of occlusion (proximal vs. distal). Distal occlusion was defined as occlusion of M3 segment of the middle cerebral artery, any segment of the anterior cerebral artery, or any segment of the posterior cerebral artery. Only isolated distal occlusion was included. Good outcome was defined as 90-day modified Rankin scale score 0-2. RESULTS: A total of 4710 patients were included in this study, of whom 189 (4%) had MT for distal occlusions. Compared with the proximal occlusion group, distal occlusion group had a higher rate of good outcome (45% vs. 36%; P = 0.03) and a lower rate of successful reperfusion (78% vs. 84%; P = 0.04). However, the differences did not retain significance in adjusted models. Otherwise there was no difference in the rate of hemorrhagic complications, mortality, or procedure-related complications between the 2 groups. Successful reperfusion, age, and admission stroke severity emerged as predictors of good functional outcome in the distal occlusion group. CONCLUSIONS: Thrombectomies of distal vessels achieve high rate of successful reperfusion with similar safety profile to those in more proximal locations.