Endovascular treatment of distal medium vessel occlusions using microcatheter aspiration thrombectomy

医学 外科 血管内治疗 冲程(发动机) 放射科 动脉瘤 机械工程 工程类
作者
Dominik Grieb,Björn Greling,Katharina Schulz,Frederik Boxberg,Katharina Melber,Omar Abu-Fares,Heinrich Lanfermann,Martin Schlunz‐Hendann,Dan Meila
出处
期刊:Interventional Neuroradiology [SAGE]
卷期号:30 (2): 234-241 被引量:12
标识
DOI:10.1177/15910199221133470
摘要

Background and purpose Recent studies suggest that endovascular treatment (EVT) in distal medium vessel occlusion (DMVO) stroke is beneficial even beyond middle cerebral artery (MCA) - M2 segment. However, data about aspiration thrombectomy of DMVOs is scarce since common state-of-the-art aspiration catheters are usually too large for small distal intracranial arteries. We report our initial experiences using the microcatheter aspiration thrombectomy (MAT) technique as frontline therapy for acute DMVOs in the MCA territory. Methods We retrospectively analyzed all acute ischemic stroke (AIS) patients that underwent MAT of a primary or secondary DMVO in the M3 or M4 segment between January 2019 and October 2021. Recanalization rates, procedural safety and outcome data were recorded. Results MAT of acute M3 and M4 occlusions was performed in 19 patients with AIS. Six had isolated DMVO strokes, 13 had secondary DMVOs during EVT of a proximal large vessel occlusion. Successful revascularization to DMVO TICI ≥ 2b was achieved in 58% (11/19) with a single pass in all of them. The median National Institutes of Health Strokes Scale (NIHSS) score at admission and discharge was 12 and 3, respectively. 68% (13/19) of the patients had a good clinical outcome at discharge (modified Rankin Scale 0-2). No symptomatic complications related to MAT occurred. Conclusions MAT of DMVOs in the MCA territory is technically feasible and effective. Compared to stent retriever-based thrombectomy in DMVOs the hemorrhagic complication rate appears notably lower. Further studies are needed to validate the benefit of mechanical thrombectomy in the distal intracranial vasculature.
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