Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study.
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Salim Hamza Adel, Yedavalli Vivek, Lakhani Dhairya A, Milhem Fathi, Musmar Basel, Adeeb Nimer, Faizy Tobias D, Daraghma Motaz, El Naamani Kareem, Henninger Nils, Sundararajan Sri Hari, Kuhn Anna Luisa, Khalife Jane, Ghozy Sherief, Scarcia Luca, Grewal Inayat, Yeo Leonard Ll, Tan Benjamin Yq, Regenhardt Robert W, Heit Jeremy Josef, Cancelliere Nicole M, Rouchaud Aymeric, Fiehler Jens, Sheth Sunil A, Puri Ajit S, Dyzmann Christian, Colasurdo Marco, Renieri Leonardo, Filipe João Pedro, Harker Pablo, Radu Răzvan Alexandru, Abdalkader Mohamad, Klein Piers, Marotta Thomas R, Spears Julian, Ota Takahiro, Mowla Ashkan, Jabbour Pascal, Biswas Arundhati, Clarençon Frédéric, Siegler James E, Nguyen Thanh N, Varela Ricardo, Baker Amanda, Essibayi Muhammed Amir, Altschul David, Gonzalez Nestor, Möhlenbruch Markus A, Costalat Vincent, Gory Benjamin, Stracke Christian Paul, Hecker Constantin, Marnat Gaultier, Shaikh Hamza, Griessenauer Christoph J, Liebeskind David S, Pedicelli Alessandro, Alexandre Andrea Maria, Tancredi Illario, Kalsoum Erwah, Lubicz Boris, Patel Aman B, Mendes Pereira Vitor, Wintermark Max, Guenego Adrien, Dmytriw Adam A, MAD MT Investigators
Аннотация
METHODS: A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke w-ho underwent MT between September 2017 and July 2023. ENT was defined as filling defects in previously unaffected territories, excluding embolization near the original occlusion, observed on final angiographic runs after retrieval of the primary thrombus. The associations between ENT, procedural variables, and 90-day clinical outcomes were evaluated, including functional independence (modified Rankin Scale (mRS) scores of 0-2), excellent outcomes (mRS 0-1), mortality, and hemorrhagic complications.
RESULTS: ENT occurred in 2.9% (63/2122) of patients. Longer onset-to-arterial puncture time (adjusted OR 1.03; 95% CI 1.01 to 1.05; P=0.002) and a greater number of passes (adjusted OR 1.15; 95% CI 1.01 to 1.32; P=0.032) were associated with increased ENT risk, while excellent recanalization (thrombolysis in cerebral infarction (TICI) scale score 2c-3) was associated with reduced ENT risk (adjusted OR 0.41; 95% CI 0.23 to 0.72; P=0.002). ENT was not associated with poorer functional independence, mortality, or hemorrhagic complications.
CONCLUSIONS: ENT during MT for MeVO stroke occurs infrequently and does not significantly affect the clinical outcomes. These findings suggest ENT risk should not deter clinicians from performing MT in patients with MeVO. Further prospective studies are needed to validate these results.