Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR

Nisha Dabhi¹, Jeyan Sathia Kumar¹, Natasha Ironside¹, Ryan T Kellogg¹, Mohammad-Mahdi Sowlat², Kazutaka Uchida³, Ilko Maier⁴, Sami Al Kasab², Pascal Jabbour⁵, Joon-Tae Kim⁶, Stacey Q Wolfe⁷, Ansaar Rai⁸, Robert M Starke^{9

10}, Marios-Nikos Psychogios¹¹, Edgar A Samaniego¹², Adam S Arthur^{13

14}, Shinichi Yoshimura³, Hugo Cuellar¹⁵, Brian M Howard^{16

17}, Ali Alawieh¹⁶, Daniele G Romano¹⁸, Omar Tanweer¹⁹, Justin Mascitelli²⁰, Isabel Fragata²¹, Adam J Polifka²², Joshua W Osbun²³, Roberto Javier Crosa²⁴, Charles Matouk²⁵, Michael R Levitt²⁶, Waleed Brinjikji²⁷, Mark Moss²⁸, Travis M Dumont²⁹, Richard Williamson³⁰, Pedro Navia³¹, Peter Kan³², Reade De Leacy³³, Shakeel A Chowdhry³⁴, Mohamad Ezzeldin^{35

36}, Alejandro M Spiotta², Min S Park³⁷

Affiliations

¹ Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
² Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
³ Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
⁴ Department of Neurosurgery, University Medicine Goettingen, Goettingen, Germany.
⁵ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁶ Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Korea (the Republic of).
⁷ Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
⁸ Department of Neurosurgery, West Virginia University Hospitals, Morgantown, West Virginia, USA.
⁹ Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁰ Neurosurgery, University of Miami School of Medicine, Miami, Florida, USA.
¹¹ Department of Neurosurgery, University Hospital Basel, Basel, Switzerland.
¹² Department of Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹³ Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
¹⁴ Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹⁵ Department of Neurosurgery, LSUHSC, Shreveport, Louisiana, USA.
¹⁶ Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁷ Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁸ Department of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
¹⁹ Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
²⁰ Deparment of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
²¹ Department of Neurosurgery, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
²² Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
²³ Department of Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
²⁴ Department of Neurosurgery, Médica Uruguaya, Montevideo, Uruguay.
²⁵ Department of Neurosurgery, Yale University, New Haven, Connecticut, USA.
²⁶ Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington, USA.
²⁷ Department of Neurosurgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
²⁸ Department of Neurosurgery, Washington Regional Medical Center, Fayetteville, Arkansas, USA.
²⁹ Department of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA.
³⁰ Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
³¹ Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain.
³² Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
³³ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³⁴ Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA.
³⁵ Department of Neurosurgery, University of Houston, Houston, Texas, USA.
³⁶ Neuroendovascular Surgery, HCA Houston, Houston, Texas, USA.
³⁷ Department of Neurosurgery, Universitätsspital Basel, Basel, Switzerland MP2TQ@uvahealth.org.

PMID: 37968114
DOI: 10.1136/jnis-2023-020997

Multicenter Study

Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR

Nisha Dabhi et al. J Neurointerv Surg. 2024.

. 2024 Nov 22;16(12):1282-1287.

doi: 10.1136/jnis-2023-020997.

Authors

Affiliations

¹ Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
² Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
³ Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
⁴ Department of Neurosurgery, University Medicine Goettingen, Goettingen, Germany.
⁵ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁶ Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Korea (the Republic of).
⁷ Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
⁸ Department of Neurosurgery, West Virginia University Hospitals, Morgantown, West Virginia, USA.
⁹ Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁰ Neurosurgery, University of Miami School of Medicine, Miami, Florida, USA.
¹¹ Department of Neurosurgery, University Hospital Basel, Basel, Switzerland.
¹² Department of Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹³ Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
¹⁴ Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹⁵ Department of Neurosurgery, LSUHSC, Shreveport, Louisiana, USA.
¹⁶ Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁷ Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁸ Department of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
¹⁹ Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
²⁰ Deparment of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
²¹ Department of Neurosurgery, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
²² Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
²³ Department of Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
²⁴ Department of Neurosurgery, Médica Uruguaya, Montevideo, Uruguay.
²⁵ Department of Neurosurgery, Yale University, New Haven, Connecticut, USA.
²⁶ Department of Neurosurgery, University of Washington School of Medicine, Seattle, Washington, USA.
²⁷ Department of Neurosurgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
²⁸ Department of Neurosurgery, Washington Regional Medical Center, Fayetteville, Arkansas, USA.
²⁹ Department of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA.
³⁰ Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
³¹ Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain.
³² Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
³³ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³⁴ Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA.
³⁵ Department of Neurosurgery, University of Houston, Houston, Texas, USA.
³⁶ Neuroendovascular Surgery, HCA Houston, Houston, Texas, USA.
³⁷ Department of Neurosurgery, Universitätsspital Basel, Basel, Switzerland MP2TQ@uvahealth.org.

PMID: 37968114
DOI: 10.1136/jnis-2023-020997

Abstract

Background: The safety and efficacy of mechanical thrombectomy (MT) for the treatment of acute anterior cerebral artery (ACA) occlusions have not clearly been delineated. Outcomes may be impacted based on whether the occlusion is isolated to the ACA (primary ACA occlusion) or occurs in conjunction with other cerebral arteries (secondary).

Methods: We performed a retrospective review of the multicenter Stroke Thrombectomy and Aneurysm (STAR) database. All patients with MT-treated primary or secondary ACA occlusions were included. Baseline characteristics, procedural outcomes, complications, and clinical outcomes were collected. Primary and secondary ACA occlusions were compared using the Mann-Whitney U test and Kruskal-Willis test for continuous variables and the χ² test for categorical variables.

Results: The study cohort comprised 238 patients with ACA occlusions (49.2% female, median (SD) age 65.6 (16.7) years). The overall rate of successful recanalization was 75%, 90-day good functional outcome was 23%, and 90-day mortality was 35%. There were 44 patients with a primary ACA occlusion and 194 patients with a secondary ACA occlusion. When adjusted for baseline variables, the rates of successful recanalization (68% vs 76%, P=0.27), 90-day good functional outcome (41% vs 19%, P=0.38), and mortality at 90 days (25% vs 38%, P=0.12) did not differ between primary and secondary ACA occlusion groups.

Conclusion: Clinical and procedural outcomes are similar between MT-treated primary and secondary ACA occlusions for select patients. Our findings demonstrate the need for established criteria to determine ideal patient and ACA stroke characteristics amenable to MT treatment.

Keywords: stroke; thrombectomy.

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Conflict of interest statement

Competing interests: KU receives lecture fees from Daiichi-Sankyo, Bristol-Myers Squibb, Stryker, and Medtronic. SY receives lecture fees from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. IM has speaker's honoraria from Pfizer and Bristol-Myers Squibb. SAK has a grant from Stryker for RESCUE-ICAS registry. RMS has research supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of Health, an unrestricted research grant from Medtronic and Balt, and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M-NP has grants from the Swiss National Science Foundation (SNF), Bangerter-Rhyner Stiftung, Stryker Neurovascular, Phenox, Penumbra, and Rapid Medical, Sponsor-PI SPINNERS trial for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), research agreements with Siemens Healthineers, and has speaker fees from Stryker Neurovascular, Medtronic, Penumbra, Acandis, Phenox, Siemens Healthineers. EAS is a consultant for Medtronic, Microvention, Rapid Medical. ASA is a consultant for Arsenal, Balt, Johnson & Johnson, Medtronic, Microvention, Penumbra, Perfuze, Scientia, Siemens, Stryker; research support from Balt, Medtronic, Microvention, Penumbra and Siemens; shareholder Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Perfuze, Revbio, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI. SY has a lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. HC is a consultant for Medtronic, Penumbra and Microvention. DGR is a consultant for Penumbra, Balt, Microvention, Phenox. OT has consulting agreements with Viz.AI, Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. Proctor: Microvention, Medtronic; educational/research grants: Q’apel, Steinberg Foundation. CM is a consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical; speaker for Penumbra and Silk Road Medical. MSP is a consultant for Medtronic. MRL has unrestricted educational grants from Medtronic and Stryker, consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative, equity interest in Proprio, Cerebrotech, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical, and makes up the editorial boards of Journal of NeuroInterventional Surgery and Frontiers in Surgery. RW is a consultant for Medtronic, Stryker, and Synaptive Medical. PN is a consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. PK has grants from the NIH (1U18EB029353-01) and unrestricted educational grants from Medtronic and Siemens, is a consultant for Imperative Care and Stryker Neurovascular, and has stock ownership in Vena Medical. RDL is a PI for Imperative Trial, has research grants from Siemens Healthineers and Kaneka Medical, is a consultant for Cerenovus, Stryker Neurovascular and Scientia Vascular, and has minor equity interest in Vastrax, Borvo Medical, Synchron, Endostream, Von Vascular. SAC is a consultant and proctor for Medtronic and Microvention. AMS has research support from Penumbra, Stryker, Medtronic, RapidAI, Avail, is a consultant for Penumbra, Stryker, Terumo, and RapidAI, and has equity in Avail.

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Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR

Affiliations

Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR

Authors

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

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