Journal article
Endovascular therapy in the distal neurovascular territory: results of a large prospective registry
Journal of neurointerventional surgery, v 44(11), pp 979-984
01 Nov 2021
PMID: 33323503
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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.
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.
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.
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Details
- Title
- Endovascular therapy in the distal neurovascular territory: results of a large prospective registry
- Creators
- Raul G Nogueira - Grady Memorial HospitalMahmoud H Mohammaden - Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USADiogo C Haussen - Grady Memorial HospitalRonald F Budzik - Riverside Methodist HospitalRishi Gupta - WellStar Health SystemAntonin Krajina - University of Hradec KrálovéJoey D English - California Pacific Medical CenterAli R Malek - Dignity HealthAmrou Sarraj - The University of Texas Health Science Center at HoustonAna Paula Narata - Université de ToursMuhammad Asif Taqi - Los Robles Hospital & Medical CenterMichael R Frankel - Grady Memorial HospitalTimothy Ryan Miller - University of Maryland, BaltimoreThomas Grobelny - Advocate Health CareBlaise W Baxter - University of Tennessee at ChattanoogaBruno Mario Bartolini - University Hospital of LausannePaul Jenkins - StrykerLaurent Estrade - Department of Interventional Neuroradiology, Centre Hospitalier Regional Universitaire de Lille, Lille, FranceDavid Liebeskind - University of California Los AngelesErol Veznedaroglu - Drexel University, Neurosurgery
- Publication Details
- Journal of neurointerventional surgery, v 44(11), pp 979-984
- Publisher
- British Medical Journal (BMJ)
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurosurgery
- Web of Science ID
- WOS:000709894600006
- Scopus ID
- 2-s2.0-85097955463
- Other Identifier
- 991019168187604721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Neuroimaging
- Surgery