Technical and clinical outcomes of thrombectomy in patients with acute medium vessel occlusion and large vessel occlusion; sub-analyses of Japan Trevo registry.

Background: Little is known about endovascular therapy (EVT) for patients with medium vessel occlusion (MeVO) and more work is needed to establish its efficacy and to understand hemorrhagic complications.
Methods: We analyzed the Japan Trevo Registry, which enrolled patients with acute stroke who underwent EVT using Trevo Retriever alone or in combination with an aspiration catheter. The primary outcome was effective reperfusion, and the secondary outcome was modified Rankin scale 0-2 at 90 days. Safety outcomes, including intracranial hemorrhage (ICH), were evaluated using a subgroup analyses focused on any ICH.
Results: Among 1041 registered patients, 1025 patients were analyzed. 253 patients had MeVOs, and the majority (89.3%) had middle cerebral artery segment 2 (M2). The median National Institutes of Health Stroke Scale scores at admission were 15 and 19 for the MeVO and LVO groups (p < 0.0001). The primary outcome was 88.9% in MeVO vs. 91.8% in LVO group: adjusted odds ratio (aOR) [95% confidence interval (CI)] 0.60 [0.35-1.03], p = 0.07, and the secondary outcome was 43.2% vs. 42.2%, and the aOR [95%CI] was 0.70 [0.48-1.002], p = 0.051. However, the incidence of any ICH was more prominent in MeVO than in LVO group (35.7% vs. 28.8%, aOR [95%CI] 1.54 [1.10-2.15], p = 0.01). In subgroup analyses, the incidences of any ICH in MeVO group were generally higher than those in LVO group.
Conclusions: The effective reperfusion rate did not differ significantly between MeVO and LVO groups. Future development of devices and treatments for MeVO with fewer hemorrhagic complications is desirable.
Competing Interests: Declaration of competing interest Dr. Kuwahara has no conflicts of interest to report. Dr. Uchida reports lecturer's fees from Daiichi Sankyo, Bristol-Myers Squibb, Stryker, and Medtronic. Dr. Sakai reports a research grant from Biomedical Solutions, Medtronic, Terumo and TG Medical; lecturer's fees from Asahi-Intec, Biomedical Solutions, Kaneka, Medtronic, and Terumo; membership on the advisory boards for Johnson&Johnson, Medtronic and Terumo. Dr. Yamagami discloses research grants from Bristol-Myers Squibb; lecturer's fees from Stryker, Medtronic, Terumo, Johnson & Johnson, and Medico's Hirata. Dr. Imamura reports lecturer's fees from Medtronic, Daiichi Sankyo, Johnson and Johnson, Stryker, Terumo, Asahi Intecc. Dr. Takeuchi reports lecturer's fees from Stryker, Daiichi-Sankyo, Johnson & Johnson. Dr. Shirakawa reports lecturer's fees from Stryker, Terumo, Johnson & Johnson and Medtronic. Dr. Sakakibara reports a manuscript fee from Medicus Shuppan. Dr. Haraguchi reports lecturer's fees from Stryker, Medtronic, Kaneka, Asahi intec, Cerenovus, Daiichi Sankyo. Dr. Kimura reports lecturer's fees from Stryker, Terumo, Medtronic, Kaneka, Asahi intec, Cerenovus, Daiichi Sankyo, Nipro, Siemens, Bayer, Nestle Japan, Lifeline and Pfizer, Dr. Shindo reports lecturer fees from Medtronic, Kaneka, Stryker, Daiichi Sankyo, Asahi-Intec, Ezai, Bayer, Abbot medical, Medicos Hirata and Johnson and Johnson.(.) Dr. Suzuki has no conflicts of interest to report. Dr. Yoshimura reports research grants from Medico's Hirata, Medtronic, and Terumo; and lecturer fees from Medtronic, Kaneka, Stryker, Daiichi Sankyo, Bristol-Meyers Squibb, and Johnson & Johnson.
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