Mechanical Thrombectomy for Distal Occlusions: Efficacy, Functional and Safety Outcomes: Insight from the STAR Collaboration

Mohammad Anadani, Ali Alawieh, Reda Chalhoub, Pascal Jabbour, Robert M. Starke, Adam Arthur, Nitin Goyal, Stacey Wolfe, Kyle M. Fargen, Jonathan A. Grossberg, Brian M. Howard, Reade De Leacy, Christopher Kellner, Peter Kan, Travis Dumont, Ansaar Rai, Joshua Osbun, Roberto Crosa, Ilko Maier, Fábio A. NascimentoMin S. Park, Michael R. Levitt, Isabel Fragata, Charles Matouk, R. Webster Crowley, Shakeel A. Chowdhry, Christopher Ogilvy, Maxim Mokin, Justin Mascitelli, Albert J. Yoo, Richard W. Williamson, Sharon Webb, Marios Nikos Psychogios, Sami Al kasab, Alejandro M. Spiotta

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Mechanical thrombectomy (MT) is the standard of care for the treatment of proximal anterior circulation large vessel occlusions. However, little is known about its efficacy and safety in the treatment of distal intracranial occlusions. Methods: This is a multicenter retrospective study of patients treated with MT at 15 comprehensive centers between January 2015 and December 2018. The study cohort was divided into 2 groups based on the location of occlusion (proximal vs. distal). Distal occlusion was defined as occlusion of M3 segment of the middle cerebral artery, any segment of the anterior cerebral artery, or any segment of the posterior cerebral artery. Only isolated distal occlusion was included. Good outcome was defined as 90-day modified Rankin scale score 0–2. Results: A total of 4710 patients were included in this study, of whom 189 (4%) had MT for distal occlusions. Compared with the proximal occlusion group, distal occlusion group had a higher rate of good outcome (45% vs. 36%; P = 0.03) and a lower rate of successful reperfusion (78% vs. 84%; P = 0.04). However, the differences did not retain significance in adjusted models. Otherwise there was no difference in the rate of hemorrhagic complications, mortality, or procedure-related complications between the 2 groups. Successful reperfusion, age, and admission stroke severity emerged as predictors of good functional outcome in the distal occlusion group. Conclusions: Thrombectomies of distal vessels achieve high rate of successful reperfusion with similar safety profile to those in more proximal locations.

Original languageEnglish (US)
Pages (from-to)e871-e879
JournalWorld neurosurgery
Volume151
DOIs
StatePublished - Jul 2021
Externally publishedYes

Keywords

  • Distal occlusion
  • Hemorrhage
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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