Clinical and radiographic outcomes after mechanical thrombectomy in medium-vessel posterior cerebral artery occlusions: Subgroup analysis from STAR.

BACKGROUND

Whereas mechanical thrombectomy (MT) has become standard-of-care treatment for patients with salvageable brain tissue after acute stroke caused by large-vessel occlusions, the results of MT in patients with medium-vessel occlusions (MEVOs), particularly in the posterior cerebral artery (PCA), are not well known.

METHODS

Using data from the international Stroke Thrombectomy and Aneurysm Registry (STAR), we assessed presenting characteristics and clinical outcomes for patients who underwent MT for primary occlusions in the P2 PCA segment. As a subanalysis, we compared the PCA MeVO outcomes with STAR's anterior circulation MeVO outcomes, namely middle cerebral artery (MCA) M2 and M3 segments.

RESULTS

Of the 9812 patients in STAR, 43 underwent MT for isolated PCA MeVOs. The patients' median age was 69 years (interquartile range 61-79), and 48.8% were female. The median NIH Stroke Scale score was 9 (range 6-17). After recanalization, 67.4% of patients achieved successful recanalization (modified treatment in cerebral infarction score [mTICI] ≥ 2b), with a first-pass success rate of 44.2%, and 39.6% achieved a modified Rankin score of 0-2 at 90 days. Nine patients (20.9%) had died by the 90-day follow-up. In comparison with M2 and M3 MeVOs, there were no differences in presenting characteristics among the three groups. Patients with PCA MeVOs were less likely to undergo intra-arterial thrombolysis (4.7% PCA vs. 10.1% M2 vs. 16.2% M3, p = 0.046) or to achieve successful recanalization (mTICI ≥ 2b, 67.4%, 86.7%, 82.3%, respectively, p < 0.001); however, there were no differences in the rates of successful first-pass recanalization (44.2%, 49.8%, 52.3%, respectively, p = 0.65).

CONCLUSIONS

We describe the STAR experience performing MT in patients with PCA MeVOs. Our analysis supports that successful first-pass recanalization can be achieved in PCA MEVOs at a rate similar to that in MCA MeVOs, although further study and possible innovation may be necessary to improve successful PCA MeVO recanalization rates.

Déclaration de conflit d'intérêts

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. IM: payment or honoraria from Pfizer and Bristol-Myers Squibb. RMS: grants from or contracts with NREF, Joe Niekro Foundation, Brain Aneursym Foundation, Bee Foundation, Department of Health Biomedical Research Grant, National Institutes of Health, Medtronic, and Balt; consulting for Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, and Von Medical Optimize Vascular. MNP: grants from or contracts with Swiss National Science Foundation, Bangerter-Rhyner Stiftung, and Stryker. SY: payment or honoraria from Stryker, Medtronic, Johnson & Johnson, and Kaneka Medics for lectures. HC: consulting for Medtronic and Microvention. AAlaraj: consulting for Cerenovus. ME: grants from or contracts with Siemens Healthineers and Kaneka Medical; consulting for Viz.ai and Imperative Care; and stock in Galaxy Therapeutics. DGR: consulting for Penumbra, Balt, Microvention, and Phenox. OT: grants from QApel Inc and Steinberg Foundation; consulting for Viz.ai, Penumbra, Balt, Stryker, and Imperative; and payment or honoraria from Microvention and Medtronic. CM: NIH Grant; consulting for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical; and payment or honoraria from Penumbra and Silk Road Medical. MSP: consulting for Medtronic. MRL: grants from Medtronic and Siemens; consulting for Medtronic, Aeaean Advisers, and Metis Innovative; board participation at Arsenal Medical; editorial board participation at Journal of NeuroInterventional Surgery; and stock in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical. WB: royalties or licenses from Medtronic and Balloon Guide Catheter Technology; consulting for Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt; leadership role in MIVI Neurovascular, Marblehead Medical LLC, Inventional Neuroradiology journal, Piraeus Medical, and WFITN; and stock in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. RW: consulting for Medtronic, Stryker, and Synaptive Medical;PN: consulting for Penumbra, Medtronic, Stryker, Cerenovus, and Balt. PK: grants from NIH, Medtronic, and Siemens; consulting for Imperative Care and Stryker Neurovascular; and stock in Vena Medical. RDL: grants or contracts from Siemens Healthineers and Kaneka Medical; consulting for Cerenovus, Stryker Neurovascular, and Sim & Cure; stock in Vastrax, Borvo Medical, Synchron, Endostream, Von Vascular, Radical Catheters, Precision Recovery Inc; and other interests in PI for Imperative Trial. SC: consulting for Medtronic and Microvention. DJA: grant or contract with The Bee Foundation; consulting for MicroVention, Stryker, QApel, Synchron, and Cerenovus; and stock in Von Vascular. ASpiotta: consulting for Penumbra, Terumo, RapidAI, and Cerenovus. RG: consulting for Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular.