Multicenter investigation of technical and clinical outcomes after thrombectomy for Proximal Medium Vessel Occlusion (pMeVO) by frontline technique

医学 倾向得分匹配 冲程(发动机) 回顾性队列研究 闭塞 支架 队列 逻辑回归 外科 第一次通过 内科学 数学 机械工程 算术 工程类
作者
Jonathan A Grossberg,Reda Chalhoub,Sami Al Kasab,Dominika Pullmann,Pascal Jabbour,Marios Psychogios,Robert M. Starke,Adam S Arthur,Kyle M Fargen,Reade De Leacy,Peter Kan,Travis M. Dumont,Ansaar Rai,Roberto Crosa,Kareem El Naamani,Ilko Maier,Nitin Goyal,Stacey Q Wolfe,C. Michael Cawley,J Mocco,Muhammad Ubaid Hafeez,Brian M. Howard,Laurie Dimisko,Hassan Saad,Christopher S. Ogilvy,R. Webster Crowley,Justin Mascitelli,Isabel Fragata,Michael R. Levitt,Alejandro M Spiotta,Ali Alawieh
出处
期刊:Interventional Neuroradiology [SAGE Publishing]
卷期号:: 159101992211381-159101992211381 被引量:6
标识
DOI:10.1177/15910199221138139
摘要

Background Endovascular thrombectomy(EVT) is the standard of care for large vessel occlusion(LVO) stroke. Data on technical and clinical outcome in proximal medium vessel occlusions(pMeVOs) comparing frontline techniques remain limited. Methods We report an international multicenter retrospective study of patients undergoing EVT for stroke at 32 centers between 2015–2021. Patients were divided into LVOs(ICA/M1/Vertebrobasilar) or pMeVOs(M2/A1/P1) and categorized by thrombectomy technique. Primary outcome was 90-day good functional outcome(mRS ≤ 2). Multivariate logistic regressions were used to evaluate the impact of technical variables on clinical outcomes. Propensity score matching was used to compare outcome in patients with pMeVO treated with aspiration versus stent-retriever. Results In the cohort of 5977 LVO and 1287 pMeVO patients, pMeVO did not independently predict good-outcome(p = 0.55). In pMeVO patients, successful recanalization irrespective of frontline technique(aOR = 3.2,p < 0.05), procedure time ≤ 1-h(aOR = 2.2,p < 0.05), and thrombectomy attempts ≤ 4(aOR = 2.8,p < 0.05) were independent predictors of good-outcomes. In a propensity-matched cohort of aspiration versus stent-retriever pMeVO patients, there was no difference in good-outcomes. The rates of hemorrhage were higher(9%vs.4%,p < 0.01) and procedure time longer(51-min vs. 33-min,p < 0.01) with stent-retriever, while the number of attempts was higher with aspiration(2.5vs.2,p < 0.01). Rates of hemorrhage and good-outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group compared to attempts in the stent-retriever group. Conclusions Clinical outcomes following EVT for pMeVO are comparable to those in LVOs. The golden hour or 3-pass rules in LVO thrombectomy still apply to pMeVO thrombectomy. Different techniques may exhibit different futility metrics; SR thrombectomy was more influenced by attempts whereas aspiration was more dependent on procedure time.
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