Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

Lukas Meyer¹, Paul Stracke^{1

2

3}, Marta Wallocha⁴, Gabriel Broocks¹, Peter Sporns¹, Eike I Piechowiak⁵, Johannes Kaesmacher^{5

6}, Christian Maegerlein⁷, Moritz Roman Hernandez Petzsche⁷, Franziska Dorn⁸, Hanna Zimmermann⁸, Weis Naziri^{9

10}, Nuran Abdullayev¹¹, Christoph Kabbasch¹¹, Daniel Behme¹², Ala Jamous¹², Volker Maus¹³, Sebastian Fischer^{1

13}, Markus Möhlenbruch¹⁴, Charlotte S Weyland¹⁴, Sönke Langner¹⁵, Dan Meila¹⁶, Milena Miszczuk¹⁷, Eberhard Siebert¹⁷, Stephan Lowens¹⁸, Lars Udo Krause¹⁹, Leonard Yeo^{20

21}, Benjamin Tan^{20

21}, Anil Gopinathan^{22

21}, Benjamin Gory^{23

24}, Jorge Galván-Fernández²⁵, Miguel Schüller²⁵, Pedro Navia²⁶, Eytan Raz²⁷, Maksim Shapiro²⁷, Fabian Arnberg²⁸, Kamil Zeleňák²⁹, Mario Martínez-Galdámez²⁵, Andreas Kastrup³⁰, Panagiotis Papanagiotou^{31

32}, André Kemmling³³, Marios Psychogios³, Tommy Andersson^{28

34}, Rene Chapot⁴, Jens Fiehler¹, Uta Hanning¹; from the TOPMOST Study Group

Affiliations

¹ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.).
² Department of Interventional Neuroradiology, University Hospital Muenster, Germany (P.S.).
³ Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S., M.P.).
⁴ Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Germany (M.W., R.C.).
⁵ Institute of Diagnostic and Interventional Neuroradiology (E.I.P., J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland.
⁶ Institute of Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland.
⁷ Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.).
⁸ Institute of Neuroradiology, University Hospitals, LMU Munich, Germany (F.D., H.Z.).
⁹ Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.).
¹⁰ Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.).
¹¹ Department of Neuroradiology, University of Cologne, Germany (N.A., C.K.).
¹² Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Germany (D.B., A.J.).
¹³ Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Germany (V.M., S.F.).
¹⁴ Department of Neuroradiology, Heidelberg University Hospital, Germany (M.M., C.S.W.).
¹⁵ Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, University Hospital Rostock, Germany (S.L.).
¹⁶ Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany (D.M.).
¹⁷ Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Germany (M.M., E.S.).
¹⁸ Department of Radiology (S.L.), Klinikum Osnabrück, Germany.
¹⁹ Department of Neurology (L.U.K.), Klinikum Osnabrück, Germany.
²⁰ Division of Neurology, Department of Medicine (L.Y., B.T.), National University Health System, Singapore.
²¹ Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.).
²² Department of Diagnostic imaging (A.G.), National University Health System, Singapore.
²³ Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, France (B.G.).
²⁴ Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France (B.G.).
²⁵ Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.).
²⁶ Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.).
²⁷ Department of Radiology, New York Langone Medical Center (E.R., M.S.).
²⁸ Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.).
²⁹ Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.).
³⁰ Department of Neurology, Hospital Bremen-Mitte, Germany (A.K.).
³¹ Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.).
³² Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Greece (P.P.).
³³ Department of Neuroradiology, University Hospital Marburg, Germany (A.K.).
³⁴ Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.).

PMID: 35443785
DOI: 10.1161/STROKEAHA.121.037792

Multicenter Study

Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

Lukas Meyer et al. Stroke. 2022 Aug.

. 2022 Aug;53(8):2449-2457.

doi: 10.1161/STROKEAHA.121.037792. Epub 2022 Apr 21.

Authors

Affiliations

¹ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.).
² Department of Interventional Neuroradiology, University Hospital Muenster, Germany (P.S.).
³ Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S., M.P.).
⁴ Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Germany (M.W., R.C.).
⁵ Institute of Diagnostic and Interventional Neuroradiology (E.I.P., J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland.
⁶ Institute of Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland.
⁷ Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.).
⁸ Institute of Neuroradiology, University Hospitals, LMU Munich, Germany (F.D., H.Z.).
⁹ Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.).
¹⁰ Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.).
¹¹ Department of Neuroradiology, University of Cologne, Germany (N.A., C.K.).
¹² Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Germany (D.B., A.J.).
¹³ Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Germany (V.M., S.F.).
¹⁴ Department of Neuroradiology, Heidelberg University Hospital, Germany (M.M., C.S.W.).
¹⁵ Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, University Hospital Rostock, Germany (S.L.).
¹⁶ Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany (D.M.).
¹⁷ Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Germany (M.M., E.S.).
¹⁸ Department of Radiology (S.L.), Klinikum Osnabrück, Germany.
¹⁹ Department of Neurology (L.U.K.), Klinikum Osnabrück, Germany.
²⁰ Division of Neurology, Department of Medicine (L.Y., B.T.), National University Health System, Singapore.
²¹ Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.).
²² Department of Diagnostic imaging (A.G.), National University Health System, Singapore.
²³ Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, France (B.G.).
²⁴ Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France (B.G.).
²⁵ Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.).
²⁶ Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.).
²⁷ Department of Radiology, New York Langone Medical Center (E.R., M.S.).
²⁸ Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.).
²⁹ Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.).
³⁰ Department of Neurology, Hospital Bremen-Mitte, Germany (A.K.).
³¹ Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.).
³² Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Greece (P.P.).
³³ Department of Neuroradiology, University Hospital Marburg, Germany (A.K.).
³⁴ Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.).

PMID: 35443785
DOI: 10.1161/STROKEAHA.121.037792

Abstract

Background: The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation.

Methods: TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events.

Results: A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62-81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; P=0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; P=0.933) and modified Rankin Scale rates (modified Rankin Scale score 0-1, aspiration: 60.5% versus stent retriever 68.6%; P=0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95-0.99]; P<0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16-9.21]; P<0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases.

Conclusions: Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.

Keywords: cerebrovascular disease/stroke; ischemic stroke; posterior circulation; thrombectomy.

PubMed Disclaimer

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
- The YODA Project
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

Affiliations

Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

Authors

Affiliations

Abstract

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous