1. Mechanical Thrombectomy for Distal Occlusions: Efficacy, Functional and Safety Outcomes: Insight from the STAR Collaboration
- Author
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Nitin Goyal, Mohammad Anadani, Sami Al Kasab, Peter Kan, Richard Williamson, Christopher S. Ogilvy, Reda M. Chalhoub, Maxim Mokin, Ali Alawieh, Robert M. Starke, Brian M. Howard, Justin R Mascitelli, Kyle M Fargen, Sharon Webb, Joshua W. Osbun, Ansaar T Rai, Min S. Park, Albert J Yoo, Reade De Leacy, Alejandro M Spiotta, Shakeel A. Chowdhry, Isabel Fragata, Travis M. Dumont, Roberto Crosa, Jonathan A Grossberg, R. Webster Crowley, Charles C. Matouk, Michael R. Levitt, Ilko Maier, Marios Psychogios, Christopher P. Kellner, Pascal Jabbour, Stacey Q Wolfe, Fábio A. Nascimento, and Adam S Arthur
- Subjects
Adult ,medicine.medical_specialty ,Posterior cerebral artery ,03 medical and health sciences ,0302 clinical medicine ,Modified Rankin Scale ,medicine.artery ,Occlusion ,Anterior cerebral artery ,Humans ,Medicine ,Stroke ,Aged ,Retrospective Studies ,Thrombectomy ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Middle cerebral artery ,Cohort ,Cerebral Arterial Diseases ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - 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.
- Published
- 2021