TY - JOUR
T1 - Multicenter investigation of technical and clinical outcomes after thrombectomy for Proximal Medium Vessel Occlusion (pMeVO) by frontline technique
AU - on behalf of the STAR Collaborators
AU - Grossberg, Jonathan A.
AU - Chalhoub, Reda M.
AU - Al Kasab, Sami
AU - Pullmann, Dominika
AU - Jabbour, Pascal
AU - Psychogios, Marios
AU - Starke, Robert M.
AU - Arthur, Adam S.
AU - Fargen, Kyle M.
AU - De Leacy, Reade
AU - Kan, Peter
AU - Dumont, Travis
AU - Rai, Ansaar
AU - Crosa, Roberto J.
AU - Naamani, Kareem E.
AU - Maier, Ilko
AU - Goyal, Nitin
AU - Wolfe, Stacey Quintero
AU - Michael Cawley, C.
AU - Mocco, J.
AU - Hafeez, Muhammad
AU - Howard, Brian M.
AU - Dimisko, Laurie
AU - Saad, Hassan
AU - Ogilvy, Christopher S.
AU - Webster Crowley, R.
AU - Mascitelli, Justin
AU - Fragata, Isabel
AU - Levitt, Michael
AU - Spiotta, Alejandro M.
AU - Alawieh, Ali M.
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2024/8
Y1 - 2024/8
N2 - Background: Endovascular thrombectomy(EVT) is the standard of care for large vessel occlusion(LVO) stroke. Data on technical and clinical outcome in proximal medium vessel occlusions(pMeVOs) comparing frontline techniques remain limited. Methods: We report an international multicenter retrospective study of patients undergoing EVT for stroke at 32 centers between 2015–2021. Patients were divided into LVOs(ICA/M1/Vertebrobasilar) or pMeVOs(M2/A1/P1) and categorized by thrombectomy technique. Primary outcome was 90-day good functional outcome(mRS ≤ 2). Multivariate logistic regressions were used to evaluate the impact of technical variables on clinical outcomes. Propensity score matching was used to compare outcome in patients with pMeVO treated with aspiration versus stent-retriever. Results: In the cohort of 5977 LVO and 1287 pMeVO patients, pMeVO did not independently predict good-outcome(p = 0.55). In pMeVO patients, successful recanalization irrespective of frontline technique(aOR = 3.2,p < 0.05), procedure time ≤ 1-h(aOR = 2.2,p < 0.05), and thrombectomy attempts ≤ 4(aOR = 2.8,p < 0.05) were independent predictors of good-outcomes. In a propensity-matched cohort of aspiration versus stent-retriever pMeVO patients, there was no difference in good-outcomes. The rates of hemorrhage were higher(9%vs.4%,p < 0.01) and procedure time longer(51-min vs. 33-min,p < 0.01) with stent-retriever, while the number of attempts was higher with aspiration(2.5vs.2,p < 0.01). Rates of hemorrhage and good-outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group compared to attempts in the stent-retriever group. Conclusions: Clinical outcomes following EVT for pMeVO are comparable to those in LVOs. The golden hour or 3-pass rules in LVO thrombectomy still apply to pMeVO thrombectomy. Different techniques may exhibit different futility metrics; SR thrombectomy was more influenced by attempts whereas aspiration was more dependent on procedure time.
AB - Background: Endovascular thrombectomy(EVT) is the standard of care for large vessel occlusion(LVO) stroke. Data on technical and clinical outcome in proximal medium vessel occlusions(pMeVOs) comparing frontline techniques remain limited. Methods: We report an international multicenter retrospective study of patients undergoing EVT for stroke at 32 centers between 2015–2021. Patients were divided into LVOs(ICA/M1/Vertebrobasilar) or pMeVOs(M2/A1/P1) and categorized by thrombectomy technique. Primary outcome was 90-day good functional outcome(mRS ≤ 2). Multivariate logistic regressions were used to evaluate the impact of technical variables on clinical outcomes. Propensity score matching was used to compare outcome in patients with pMeVO treated with aspiration versus stent-retriever. Results: In the cohort of 5977 LVO and 1287 pMeVO patients, pMeVO did not independently predict good-outcome(p = 0.55). In pMeVO patients, successful recanalization irrespective of frontline technique(aOR = 3.2,p < 0.05), procedure time ≤ 1-h(aOR = 2.2,p < 0.05), and thrombectomy attempts ≤ 4(aOR = 2.8,p < 0.05) were independent predictors of good-outcomes. In a propensity-matched cohort of aspiration versus stent-retriever pMeVO patients, there was no difference in good-outcomes. The rates of hemorrhage were higher(9%vs.4%,p < 0.01) and procedure time longer(51-min vs. 33-min,p < 0.01) with stent-retriever, while the number of attempts was higher with aspiration(2.5vs.2,p < 0.01). Rates of hemorrhage and good-outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group compared to attempts in the stent-retriever group. Conclusions: Clinical outcomes following EVT for pMeVO are comparable to those in LVOs. The golden hour or 3-pass rules in LVO thrombectomy still apply to pMeVO thrombectomy. Different techniques may exhibit different futility metrics; SR thrombectomy was more influenced by attempts whereas aspiration was more dependent on procedure time.
KW - MEVO
KW - stroke
KW - thrombectomy
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UR - http://www.scopus.com/inward/citedby.url?scp=85142207068&partnerID=8YFLogxK
U2 - 10.1177/15910199221138139
DO - 10.1177/15910199221138139
M3 - Article
C2 - 36377352
AN - SCOPUS:85142207068
SN - 1591-0199
VL - 30
SP - 470
EP - 479
JO - Interventional Neuroradiology
JF - Interventional Neuroradiology
IS - 4
ER -