Multicenter Study

. 2024 Jul 15:462:123054.

doi: 10.1016/j.jns.2024.123054. Epub 2024 May 31.

Outcomes and differences by occluded vessel after endovascular thrombectomy for isolated medium vessel occlusions

Hidetoshi Matsukawa¹, Kazutaka Uchida², Conor Cunningham³, Mohammad-Mahdi Sowlat⁴, Sameh Samir Elawady⁴, Ilko Maier⁵, Pascal Jabbour⁶, Joon-Tae Kim⁷, Stacey Quintero Wolfe⁸, Ansaar Rai⁹, Robert M Starke¹⁰, Marios-Nikos Psychogios¹¹, Amir Shaban¹², Adam Arthur¹³, Hugo Cuellar¹⁴, Brian M Howard¹⁵, Ali Alawieh¹⁶, Daniele G Romano¹⁷, Omar Tanweer¹⁸, Justin Mascitelli¹⁹, Isabel Fragata²⁰, Adam Polifka²¹, Joshua Osbun²², Roberto Crosa²³, Charles Matouk²⁴, Min S Park²⁵, Waleed Brinjikji²⁶, Mark Moss²⁷, Richard Williamson²⁸, Pedro Navia²⁹, Peter Kan³⁰, Reade De Leacy³¹, Shakeel Chowdhry³², Mohamad Ezzeldin³³, Alejandro M Spiotta⁴, Michael R Levitt³⁴, Shinichi Yoshimura³⁵; Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators

Affiliations

¹ Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, USA; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
² Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, USA; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.
³ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
⁴ Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, USA.
⁵ Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
⁶ Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
⁷ Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea.
⁸ Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
⁹ Department of Radiology, West Virginia School of Medicine, Morgantown, USA.
¹⁰ Department of Neurosurgery, University of Miami Health System, Miami, FL, USA.
¹¹ Department of interventional and diagnostical Neuroradiology, University of Basel, Basel, Switzerland.
¹² Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, USA.
¹³ Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, USA.
¹⁴ Department of Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport, USA.
¹⁵ Emory University, Neurosurgery, Radiology and Imaging Sciences, Atlanta, USA.
¹⁶ Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
¹⁷ Department of Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy.
¹⁸ Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
¹⁹ Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA.
²⁰ Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
²¹ Department of Neurosurgery, University of Florida, Gainesville, USA.
²² Department of Neurological Surgery, Washington University, St Louis, MO, USA.
²³ Department of Neurosurgery, Endovascular Neurological Center, Montevideo, Uruguay.
²⁴ Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.
²⁵ Department of Neurosurgery, University of Virginia, Charlottesville, USA.
²⁶ Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, USA.
²⁷ Department of Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, AZ, USA.
²⁸ Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, USA.
²⁹ Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain.
³⁰ Department of Neurological Surgery, University of Texas Medical Branch - Galveston, USA.
³¹ Department of Neurosurgery, Mount Sinai Health System, New York, NY, USA.
³² Department of Neurosurgery, NorthShore University HealthSystem, Evanston, IL, USA.
³³ Department of Clinical Sciences, University of Houston, HCA Houston Healthcare Kingwood, TX, USA.
³⁴ Department of Neurosurgery, University of Washington, Seattle, USA.
³⁵ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan. Electronic address: hyogoneuro@yahoo.co.jp.

PMID: 38889600
DOI: 10.1016/j.jns.2024.123054

Multicenter Study

Outcomes and differences by occluded vessel after endovascular thrombectomy for isolated medium vessel occlusions

Hidetoshi Matsukawa et al. J Neurol Sci. 2024.

. 2024 Jul 15:462:123054.

doi: 10.1016/j.jns.2024.123054. Epub 2024 May 31.

Authors

Affiliations

¹ Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, USA; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
² Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, USA; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.
³ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
⁴ Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, USA.
⁵ Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
⁶ Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
⁷ Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea.
⁸ Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
⁹ Department of Radiology, West Virginia School of Medicine, Morgantown, USA.
¹⁰ Department of Neurosurgery, University of Miami Health System, Miami, FL, USA.
¹¹ Department of interventional and diagnostical Neuroradiology, University of Basel, Basel, Switzerland.
¹² Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, USA.
¹³ Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, USA.
¹⁴ Department of Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport, USA.
¹⁵ Emory University, Neurosurgery, Radiology and Imaging Sciences, Atlanta, USA.
¹⁶ Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
¹⁷ Department of Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy.
¹⁸ Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
¹⁹ Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA.
²⁰ Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
²¹ Department of Neurosurgery, University of Florida, Gainesville, USA.
²² Department of Neurological Surgery, Washington University, St Louis, MO, USA.
²³ Department of Neurosurgery, Endovascular Neurological Center, Montevideo, Uruguay.
²⁴ Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.
²⁵ Department of Neurosurgery, University of Virginia, Charlottesville, USA.
²⁶ Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, USA.
²⁷ Department of Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, AZ, USA.
²⁸ Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, USA.
²⁹ Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain.
³⁰ Department of Neurological Surgery, University of Texas Medical Branch - Galveston, USA.
³¹ Department of Neurosurgery, Mount Sinai Health System, New York, NY, USA.
³² Department of Neurosurgery, NorthShore University HealthSystem, Evanston, IL, USA.
³³ Department of Clinical Sciences, University of Houston, HCA Houston Healthcare Kingwood, TX, USA.
³⁴ Department of Neurosurgery, University of Washington, Seattle, USA.
³⁵ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan. Electronic address: hyogoneuro@yahoo.co.jp.

PMID: 38889600
DOI: 10.1016/j.jns.2024.123054

Abstract

Background: The outcomes of endovascular thrombectomy (EVT) for medium vessel occlusions (MeVOs) of specific vascular territories remain unknown. We aimed to investigate EVT outcomes by MeVO locations using the data from an ongoing international multicenter registry.

Methods: Patients with isolated MeVO who underwent EVT between January 2013 and December 2022 were retrospectively analyzed. Isolated MeVO was defined as an occlusion of the A2 or A3 (A2/A3), M2 or M3, and P2 or P3 (P2/P3). Outcomes included a 90-day modified Rankin score (mRS) of 0-2, successful recanalization (modified Thrombolysis in Cerebral Infarction score ≥ 2b), early neurological deterioration (END) or improvement (ENI), and 90-day mortality. END was defined as a worsening of ≥4 points from the baseline National Institutes of Health Stroke Scale (NIHSS) score within 24 h of EVT, while ENI was defined as an improvement of ≥4 points from the baseline NIHSS score within 24 h of EVT.

Results: 1744 MeVOs included. Compared to M2 occlusions (n = 1542, 88.4%), A2/A3 (n = 36, 2.1%) occlusions had lower odds of 90-day mRS 0-2 (adjusted odds ratio [aOR] 0.30, 95% confidence interval [CI] 0.11-0.80), and P2/P3 occlusions (n = 49, 2.8%) had lower odds of successful recanalization (aOR 0.19, 95% CI 0.07-0.50), and higher odds of END (aOR 3.53, 95% CI 1.35-9.25). Other outcomes showed no significant differences.

Conclusions: A2/A3 occlusions were more likely to have worse outcomes compared to M2 occlusions after EVT for patients with isolated MeVOs.

Keywords: Acute ischemic stroke; Anterior cerebral artery; Endovascular thrombectomy; Medium vessel occlusion; Outcomes.

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Conflict of interest statement

Declaration of competing interest Dr. Hidetoshi Matsukawa received a lecture fee from Daiichi-Sankyo and Stryker and consulting services fee from B. Braun. Dr. Kazutaka Uchida received a lecture fee from Daiichi-Sankyo, Bristol-Myers Squibb, Stryker, and Medtronic. Dr. Ali Alawieh: None. Dr. Charles Matouk: Consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. Speaker for Penumbra and Silk Road Medical. Contact PI for NIH Grant R21NS128641. Dr. Mohammad-Mahdi Sowlat: None. Dr. Sameh Samir Elawady: None. Dr. Ilko L Maier: speakers honoraria from Pfizer and Bristol-Myers Squibb. Dr. Pascal Jabbour: None. Dr. Joon-Tae Kim: None. Dr. Stacey Quintero Wolfe: None. Dr. Ansaar Rai: None. Dr. Robert M Starke: RMS research is 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 (R01NS111119-01A1) and (UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. RMS has 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. Dr. Marios-Nikos Psychogios: Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Grants for the DISTAL trial from Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant), Research agreement with Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. Dr. Edgar Samaniego: Consultant for Medtronic, Microvention, Cerenovus, and Rapid Medical. Dr. Adam S. Arthur: Consultant for Arsenal, Balt, Johnson and 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. Dr. Hugo Cuellar: Dr. Hugo Cuellar: Consultant for Medtronic, Penumbra and Microvention. Dr. Brian Howard: None. Dr. Daniele G. Romano: Consultant for Penumbra, Balt, Microvention, Phenox. Dr. Omar Tanweer: Consulting Agreements: Viz.AI, Inc., Penumbra, Inc., Balt, Inc.,Stryker Inc., Imperative Inc. Proctor: Microvention Inc., Medtronic Inc. Educational/Research Grants: Q'apel Inc., Steinberg Foundation. Dr. Justin Mascitelli: None. Dr. Isabel Fragata: None. Dr. Adam Polifka: Consultant for Depuy Synthes and Stryker. Dr. Joshua Osbun: None. Dr. Roberto Crosa: None. Dr. Min S. Park: Consultant for Medtronic. Dr. Waleed Brinjikji: None. Dr. Mark Moss: No conflicts or disclosures. Dr. Travis Dumont: None. Dr. Richard Williamson: Consultant for Medtronic, Stryker, and Synaptive Medical. Dr. Pedro Navia: Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. Dr. Peter Kan: Grants from the NIH (1U18EB029353–01, UG3NS128397) and unrestricted educational grant from Siemens. Consultant for Stryker Neurovascular. Stock ownership in Vena Medical, Deinde, Prometheus, Neurofine, and Vented. Editorial Board for the Journal of Neurointerventional Surgery (JNIS). Dr. Reade De Leacy: Research grants from Siemens Healthineers and Kaneka medical. Consultant for Cerenovus, Stryker Neurovascular and Scientia Vascular. Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular. Dr. Shakeel A Chowdhry: Consultant and proctor for Medtronic and Microvention. Dr. M. Ezzeldin: Speaker for Viz.ai and has stocks in Galaxy Therapeutics. Dr. Alejandro Spiotta: Research support from Penumbra, Stryker, Medtronic and RapidAI. Consultant for Penumbra, Stryker, Terumo, and RapidAI. Dr. Michael R Levitt: Stryker and Medtronic. Equity interest in Synchron, Stroke Diagnostics, Hyperion Surgical, Proprio, Apertur. Financial interest in Fluid Biomed. Consultant for Aeaean Advisers, Metis Innovative and Stereotaxis. Editorial board for Frontiers in Surgery and Journal of NeuroInterventional Surgery (JNIS). Data safety monitoring board for Arsenal Medical. Dr. Shinichi Yoshimura received a lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics.

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Outcomes and differences by occluded vessel after endovascular thrombectomy for isolated medium vessel occlusions

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Outcomes and differences by occluded vessel after endovascular thrombectomy for isolated medium vessel occlusions

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