Mechanical Thrombectomy in Patients With Cervical Artery Dissection: A Multicenter Analysis on Technical, Safety, and Functional Outcomes.

BACKGROUND AND AIMS: The safety and effectiveness of mechanical thrombectomy (MT) in patients with cervical artery dissection (CeAD) remain uncertain. This study aimed to evaluate the safety, recanalization rates, and functional outcomes of MT in LVO-AIS patients with and without CeAD.

METHODS

Retrospective multicenter study based on data prospectively collected from June 2021 to June 2024. CeAD-related LVO-AIS patients treated with MT were compared with matched anterior and posterior circulation AIS patients without CeAD. Primary outcomes included procedural adverse events, recanalization rates, and favorable functional outcomes at 3 months. A meta-analysis of similar studies from 2015 to 2025 was conducted to support generalizability.

RESULTS

Of 1861 LVO-AIS patients, 164 (8.7%) patients had a CeAD. Despite a higher prevalence of tandem occlusion (63.0% vs. 20.0%, SDM: 0.99), CeAD patients showed similar rates of overall procedural adverse events (17.7% vs. 16.3%, p = 0.684), recanalization rates (90.0% vs. 87.5%, p = 0.563), and 90-day favorable functional outcome (59.1% vs. 58.5%, p = 0.917) as compared to non-CeAD patients. Additionally, CeAD patients had a significantly lower mortality rate at 90 days (4.3% vs. 13.1%, p = 0.023). A subgroup analysis of posterior circulation LVO-AIS showed no significant differences in safety and clinical outcomes. Meta-analysis of six studies suggested better MT outcomes in CEAD-related LVO-AIS (p < 0.001, with I2 = 60.02% [13.48-83.33 95% CI]).

CONCLUSIONS

Despite procedural challenges, this multicenter study has shown that in both anterior and posterior circulation CeAD-related LVO-AIS, MT is as safe as in non-CeAD stroke patients, achieves high recanalization rates, and is associated with similar favorable functional outcomes.