Safety and effectiveness of mechanical thrombectomy for primary isolated distal vessel occlusions: A monocentric retrospective comparative study

• Published in: Journal of neuroradiology Vol. 49; no. 4; pp. 311 - 316
• Main Authors: Elhorany, Mahmoud, Rosso, Charlotte, Shotar, Eimad, Baronnet-Chauvet, Flore, Premat, Kévin, Lenck, Stéphanie, Crozier, Sophie, Corcy, Céline, Bottin, Laure, Mansour, Ossama Yassin, Talbi, Atika, El-din, El-Sayed Ali Tag, Fadel, Wael Ahmed, Sourour, Nader-Antoine, Alamowitch, Sonia, Samson, Yves, Clarençon, Frédéric
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.06.2022; Elsevier Masson
• Subjects: Acute ischemic stroke; Anterior cerebral artery occlusion; Cognitive science; Computer Science; Distal occlusion; Mechanical thrombectomy; Medical Imaging; Middle cerebral artery; Neuroscience; Outcome; Posterior cerebral artery occlusion; Radiology; Reperfusion; NIHSS; LVO; M2; M3; IVT; Middle cerebral artery; MT; BMT; MCA; AIS; Distal occlusion; mTICI; mRS; ICH; Reperfusion; Posterior cerebral artery occlusion; Acute ischemic stroke; Mechanical thrombectomy; Outcome; DVOs; Anterior cerebral artery occlusion; GA; AOL; Distal vessel occlusions; National Institutes of Health Stroke Score; modified thrombolysis in cerebral infarction scale; intravenous thrombolysis; large vessel occlusion; General anaesthesia; best medical treatment; Arterial occlusion lesion scale; modified Rankin scale; intracranial hemorrhage
• ISSN: 0150-9861
• DOI: 10.1016/j.neurad.2022.03.008

Distal vessel occlusions represent about 25-40% of acute ischemic stroke (AIS), either as primary occlusion or secondary occlusion complicating mechanical thrombectomy (MT) for large vessel occlusion. Our aim was to evaluate safety and effectiveness of MT associated with the best medical treatment (BMT) in the management of AIS patients with distal vessel occlusion in comparison with the BMT alone. Retrospective analysis was conducted on AIS patients treated by MT+BMT for primary distal vessel occlusion between 2015 and 2020, and were compared with a historic cohort managed by BMT alone between 2006 and 2015 selected based on the same inclusion criteria. A secondary analysis was conducted using propensity score matching (PSM) including the following: NIHSS, age and treatment with intravenous thrombolysis (IVT) as covariates. Of 650 patients screened, 44 patients with distal vessel occlusions treated by MT+BMT were selected and compared with 36 patients who received BMT alone. After PSM, 28 patients in each group were matched without significant difference. Good clinical outcome defined as mRS≤2 was achieved by 53.6% of the MT+BMT group and 57% of the BMT group (OR, 0.87; 95%CI, 0.3–2.4; p = 1.00). The mortality rate was comparable in both groups (7% vs. 10.7% in MT+BMT and BMT patients, respectively; OR=0.64; 95%CI, 0.1-4; p = 1.00). Symptomatic intracranial hemorrhage (ICH) was seen in only one patient treated by MT+BMT (3.6%). Mechanical thrombectomy seems to be comparable with the best medical treatment regarding the effectiveness and safety in the management of patients with distal vessel occlusions. [Display omitted] •Distal vessel occlusions (DVOs) represent about 25 - 40% of acute ischemic stroke.•There are insufficient data to ascertain whether mechanical thrombectomy (MT) plus best medical treatment (BMT) is superior to BMT alone in DVOs.•In our study, MT+BMT and BMT alone were found to achieve similar rates of good clinical outcome despite higher final successful recanalisation rate in MT+BMT group.•The 3-months mortality rate was comparable between both groups.•Despite that MT and BMT seem to be comparable in the management of DVOs, larger-sample randomised studies are warranted.