Multicenter Evaluation of Mechanical Thrombectomy for Distal Medium Vessel Occlusions With National Institute of Health Stroke Scale Scores ≥ 6 And ≤ 6

Authors

• Anna Luisa Kühn, Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
• Ajit S. Puri, Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
• Hamza Adel Salim, Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Los Angeles, USA. Hamza.sleeem@gmail.com.
• Basel Musmar, Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Los Angeles, USA.
• Sherief Ghozy, Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
• James Siegler, Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
• Hamza Shaikh, Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
• Jane Khalife, Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
• Mohamad Abdalkader, Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.Follow
• Piers Klein, Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.Follow
• Thanh N. Nguyen, Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
• Jeremy J. Heit, Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
• Robert W. Regenhardt, Brigham and Women's Hospital, Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
• Jose Danilo Diestro, Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
• Nicole M. Cancelliere, Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
• Ahmad Sweid, Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
• Kareem El Naamani, Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
• Zuha Hasan, Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
• Anil Gopinathan, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
• Abdelaziz Amllay, Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
• Lukas Meyer, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
• Anne Dusart, Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
• Flavio Bellante, Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
• Géraud Forestier, Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
• Aymeric Rouchaud, Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
• Suzana Saleme, Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
• Charbel Mounayer, Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.Follow
• Jens Fiehler, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
• Christian Dyzmann, Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
• Peter T. Kan, Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.
• Jasmeet Singh, Brigham and Women's Hospital, Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
• Marco Colasurdo, Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.

Author Type(s)

Faculty

DOI

10.1007/s00415-024-12537-4

Journal Title

Journal of Neurology

First Page

5853

Last Page

5863

Document Type

Article

Publication Date

9-1-2024

Department

Neurosurgery

Keywords

Endovascular technique, Patient outcome, Stroke, Thrombectomy, Thrombolysis

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND: While mechanical thrombectomy is considered standard of care for large vessel occlusions, scientific evidence to support treatment for distal and medium vessel occlusions remains scarce. PURPOSE: To evaluate feasibility, safety, and outcomes in patients with low National Institute of Health Stroke Scale scores undergoing mechanical thrombectomy for treatment of distal medium vessel occlusions. MATERIALS AND METHODS: Retrospective data review and analysis of prospectively maintained databases at 41 academic centers in North America, Asia, and Europe between January 2017 and January 2022. Characteristics and outcomes were compared between groups with low stroke scale score (≤ 6) versus and higher stroke scale scores (> 6). Propensity score matching using the optimal pair matching method and 1:1 ratio was performed. RESULTS: Data were collected on a total of 1068 patients. After propensity score matching, there were a total of 676 patients included in the final analysis, with 338 patients in each group. High successful reperfusion rates were seen in both groups, 90.2% in ≤ 6 and 88.7% in the > 6 stroke scale groups. The frequency of excellent and good functional outcome was seen more common in low versus higher stroke scale score patients (64.5% and 81.1% versus 39.3% and 58.6%, respectively). The 90-day mortality rate observed in the ≤ 6 stroke scale group was 5.3% versus 13.3% in the > 6 stroke scale group. CONCLUSION: Mechanical thrombectomy in distal and medium vessel occlusions, specifically in patients with low stroke scale scores is feasible, though it may not necessarily improve outcomes over IVT.

Recommended Citation

Kühn, A. L., Puri, A. S., Salim, H. A., Musmar, B., Ghozy, S., Siegler, J., Shaikh, H., Khalife, J., Abdalkader, M., Klein, P., Nguyen, T. N., Heit, J. J., Regenhardt, R. W., Diestro, J. D., Cancelliere, N. M., Sweid, A., Naamani, K. E., Hasan, Z., Gopinathan, A., Amllay, A., Meyer, L., Dusart, A., Bellante, F., Forestier, G., Rouchaud, A., Saleme, S., Mounayer, C., Fiehler, J., Dyzmann, C., Kan, P. T., Singh, J., & Colasurdo, M. (2024). Multicenter Evaluation of Mechanical Thrombectomy for Distal Medium Vessel Occlusions With National Institute of Health Stroke Scale Scores ≥ 6 And ≤ 6. Journal of Neurology, 271 (9), 5853-5863. https://doi.org/10.1007/s00415-024-12537-4