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

Author:

Almallouhi Eyad12,Findlay Matthew C34,Maier Ilko5,Jabbour Pascal6,Kim Joon-Tae7,Wolfe Stacey Quintero8ORCID,Rai Ansaar9,Starke Robert M10,Psychogios Marios-Nikos11,Shaban Amir12,Goyal Nitin13,Yoshimura Shinichi14ORCID,Cuellar Hugo15ORCID,Howard Brian16,Alawieh Ali16,Alaraj Ali17ORCID,Ezzeldin Mohamad18ORCID,Romano Daniele G19,Tanweer Omar20,Mascitelli Justin21,Fragata Isabel22ORCID,Polifka Adam23,Siddiqui Fazeel24,Osbun Joshua25,Crosa Roberto26,Matouk Charles27ORCID,Park Min S28,Levitt Michael R29,Brinjikji Waleed30,Moss Mark31,Daglioglu Ergun32,Williamson Richard33,Navia Pedro34,Kan Peter35,De Leacy Reade36,Chowdhry Shakeel37,Altschul David J38ORCID,Spiotta Alejandro1,Grandhi Ramesh3ORCID

Affiliation:

1. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA

2. Neurointerventional Surgery, Sarasota Memorial Hospital, Sarasota, FL, USA

3. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA

4. Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA

5. Klinik für Neurologie, Universitätsmedizin Göttingen, Göttingen, Germany

6. Department of Neurosurgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

7. Department of Neurology, Chonnam National University Hospital, Gwangju, Korea

8. Department of Neurological Surgery, Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, NC, USA

9. Department of Neuroradiology, West Virginia University, Morgantown, WV, USA

10. Department of Neurological Surgery, University of Miami Health System, Miami, FL, USA

11. Department of Neurology, Universitätsspital Basel, Clinic and Polyclinic for Neurology, Basel, Switzerland

12. Department of Neurology, University of Iowa, Iowa City, IA, USA

13. Department of Neurology, University of Tennessee Health Science Center/Semmes Murphey Foundation, Memphis, TN, USA

14. Department of Neurosurgery, Hyogo College of Medicine, Hyogo, Japan

15. Department of Neurosurgery, LSU Health Shreveport, Shreveport, LA, USA

16. Department of Neurosurgery, Emory University, Atlanta, GA, USA

17. Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA

18. Department of Clinical Sciences, University of Houston, HCA Houston Healthcare Kingwood, Kingwood, TX, USA

19. Neuroradiology, University Hospital ‘San Giovanni di Dio e Ruggi d'Aragona’, Salerno, Italy

20. Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA

21. Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

22. Department of Neuroradiology, NOVA Medical School, Universidade Nova de Lisboa, Portugal + Centro Hospitalar Universitário de Lisboa central, Lisboa, Portugal

23. Department of Neurosurgery, University of Florida, Gainesville, FL, USA

24. Department of Neurosciences, University of Michigan Health West, Wyoming, MI, USA

25. Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA

26. Department of Neurosurgery, Médica Uruguaya, Montevideo, Uruguay

27. Department of Neurosurgery, Yale University, New Haven, CT, USA

28. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

29. Department of Neurological Surgery, University of Washington School of Medicine, Harborview Medical Center, Washington, USA

30. Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA

31. Department of Neurosurgery, Washington Regional Medical Center, Fayetteville, AR, USA

32. Department of Neurosurgery, Health Science University, Ankara Bilkent City Hospital, Çankaya/Ankara, Turkey

33. Department of Neurology, Alleghany Hospital Network, Pittsburgh, PA, USA

34. Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain

35. Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

36. Department of Neurosurgery, Mount Sinai Health System, New York, NY, USA

37. Department of Neurosurgery, NorthShore University HealthSystem, Evanston, IL, USA

38. Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

Abstract

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.

Funder

Brain Aneurysm Foundation

Medtronic

RapidAI

Stryker

Microvention

Penumbra

Publisher

SAGE Publications

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