Endovascular therapy in the distal neurovascular territory: results of a large prospective registry.

BACKGROUND

There is a paucity of data regarding mechanical thrombectomy (MT) in distal arterial occlusions (DAO). We aim to evaluate the safety and efficacy of MT in patients with DAO and compare their outcomes with proximal arterial occlusion (PAO) strokes.

METHODS

The Trevo Registry was a prospective open-label MT registry including 2008 patients from 76 sites across 12 countries. Patients were categorized into: PAO: intracranial ICA, and MCA-M1; and DAO: MCA-M2, MCA-M3, ACA, and PCA. Baseline and outcome variables were compared across the PAO vs DAO patients with pre-morbid mRS 0-2.

RESULTS

Among 407 DAOs including 350 (86.0%) M2, 25 (6.1%) M3, 10 (2.5%) ACA, and 22 (5.4%) PCA occlusions, there were 376 DAO with pre-morbid mRS 0-2 which were compared with 1268 PAO patients. The median baseline NIHSS score was lower in DAO (13 [8-18] vs 16 [12-20], P<0.001). There were no differences in terms of age, sex, IV-tPA use, co-morbidities, or time to treatment across DAO vs PAO. The rates of post-procedure reperfusion, symptomatic intracranial hemorrhage (sICH), and 90-mortality were comparable between both groups. DAO showed significantly higher rates of 90-day mRS 0-2 (68.3% vs 56.5%, P<0.001). After adjustment for potential confounders, the level of arterial occlusion was not associated with the chances of excellent outcome (DAO for 90-day mRS 0-1: OR; 1.18, 95% CI [0.90 to 1.54], P=0.225), successful reperfusion or SICH. However, DAO patients were more likely to be functionally independent (mRS 0-2: OR; 1.45, 95% CI [1,09 to 1.92], P=0.01) or dead (OR; 1.54, 95% CI [1.06 to 2.27], P=0.02) at 90 days.

CONCLUSION

Endovascular therapy in DAO appears to result in a comparable safety and technical success profile as in PAO. The potential benefits of DAO thrombectomy should be investigated in future randomized trials.

Informations de copyright

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: RGN reports consulting fees for advisory roles with Stryker Neurovascular, Cerenovus, Medtronic, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, and Imperative Care, and stock options for advisory roles with Brainomix, Viz-AI, Corindus Vascular Robotics, Vesalio, Ceretrieve, Astrocyte, and Cerebrotech. DCH is a consultant for Stryker and Vesalio, and holds stock options at Viz.AI. RG has ownership interest/royalties from UpToDate and is a consultant for Stryker, Medtronic, and Rapid Medical. AK is a consultant for Stryker. JDE is a consultant for Penumbra, Medtronic, and Stryker. ARM is a proctor for Stryker and consultant for InNeuroCo. AS reports research grants from, and is consultant for, Stryker. MAT is a consultant for Stryker, Rapid Medical, Balt USA, and Medtronic. MRF is a consultant for Nico Corporation. BWB is a consultant for Stryker, Penumbra, Medtronic, Cerenovus, Route 92 Medical, and Artio Medical, and has stock/stock options/equity in Penumbra, Viz.ai, Rapid Medical, Route 92 Medical, Artio Medical, 880 Medical, and Marblehead Medical. PJ is a consultant for Stryker. BMB, is a consultant for Stryker. DL is a consultant for Cerenovus, Genentech, Medtronic, Rapid Medical, Stryker, and Vesalio. EV is a consultant for Stryker, patent holder and scientific advisor for Penumbra, is a Trice consultant, and holds a Mizuho patent.