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

Autor:	Grossberg JA; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA., Chalhoub RM; Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA., Al Kasab S; Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA., Pullmann D; Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA., Jabbour P; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA., Psychogios M; Department of Radiology, University of Basel, Basel, Switzerland., Starke RM; Department of Neurosurgery, University of Miami Health System, Miami, FL, USA., Arthur AS; Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, TN, USA., Fargen KM; Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, NC, USA., De Leacy R; Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA., Kan P; Department of Neurosurgery, Baylor University, Houston, TX, USA., Dumont T; Department of Surgery, University of Arizona, Tucson, AZ, USA., Rai A; Department of Radiology, West Virginia School of Medicine, Morgantown, WV, USA., Crosa RJ; Department of Neurosurgery, Centro Endovascular Neurologico Medica Uruguaya, Montevideo, Uruguay., Naamani KE; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA., Maier I; Department of Neurology, University Medical Center Göttingen, Göttingen, Germany., Goyal N; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA., Wolfe SQ; Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, NC, USA., Michael Cawley C; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA., Mocco J; Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA., Hafeez M; Department of Neurosurgery, Baylor University, Houston, TX, USA., Howard BM; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA., Dimisko L; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA., Saad H; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA., Ogilvy CS; Department of Neurosurgery, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA., Webster Crowley R; Department of Neurosurgery, Rush University, Chicago, IL, USA., Mascitelli J; Department of Neurosurgery, University of Texas San Antonio, San Antonio, TX, USA., Fragata I; Neuroradiology Department, Hospital São José, Centro Hospitalar Lisboa Central, Lisbon, Portugal., Levitt M; Department of Neurosurgery, University of Washington, Seattle, WA, USA., Spiotta AM; Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA., Alawieh AM
Jazyk:	angličtina
Zdroj:	Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences [Interv Neuroradiol] 2024 Aug; Vol. 30 (4), pp. 470-479. Date of Electronic Publication: 2022 Nov 14.
DOI:	10.1177/15910199221138139
Abstrakt:	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. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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