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Updated: Mar 26, 2026
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Effect of endovascular reperfusion in relation to site of arterial occlusion
Robin Lemmens1, Scott A Hamilton2, David S Liebeskind2
1From KU Leuven, University of Leuven, Belgium, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (R.L.); University Hospitals Leuven, Department of Neurology (R.L.); VIB, Vesalius Research Center, Laboratory of Neurobiology (R.L.); Stanford Stroke Center (S.A.H., M.P.M., G.W.A., M.G.L.), Stanford University of Medicine, CA; Neurovascular Imaging Research Core and Department of Neurology and Comprehensive Stroke Center (D.S.L., J.L.S.), and Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine (R.J.), University of California, Los Angeles; Departments of Radiology (T.A.T.) and Neurology (J.P.B.), University of Cincinnati Medical Center, OH; Departments of Clinical Neurosciences and Radiology (A.M.D.), Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Canada; Departments of Neurology, Neurosurgery, and Radiology (R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA; Department of Diagnostic and Interventional Neuroradiology (J.G.), University Hospital Bern, Switzerland; Division of Diagnostic and Interventional Neuroradiology (A.J.Y.), Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Public Health Sciences (S.D.Y., Y.Y.P.), Medical University of South Carolina, Charleston; and Division of Neuroradiology, Department of Medical Imaging, and Division of Neurosurgery, Department of Surgery (V.M.P.), Toronto Western Hospital, University Health Network, Canada. robin.lemmens@uzleuven.be.
Objective:
To assess whether the association between reperfusion and improved clinical outcomes after stroke differs depending on the site of the arterial occlusive lesion (AOL).
Methods:
We pooled data from Solitaire With the Intention for Thrombectomy (SWIFT), Solitaire FR Thrombectomy for Acute Revascularisation (STAR), Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2 (DEFUSE 2), and Interventional Management of Stroke Trial (IMS III) to compare the strength of the associations between reperfusion and clinical outcomes in patients with internal carotid artery (ICA), proximal middle cerebral artery (MCA) (M1), and distal MCA (M2/3/4) occlusions.
Results:
Among 710 included patients, the site of the AOL was the ICA in 161, the proximal MCA in 389, and the distal MCA in 160 patients (M2 = 131, M3 = 23, and M4 = 6). Reperfusion was associated with an increase in the rate of good functional outcome (modified Rankin Scale [mRS] score 0-2) in patients with ICA (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.7-7.2) and proximal MCA occlusions (OR 6.2, 95% CI 3.8-10.2), but not in patients with distal MCA occlusions (OR 1.4, 95% CI 0.8-2.6). Among patients with M2 occlusions, a subset of the distal MCA cohort, reperfusion was associated with excellent functional outcome (mRS 0-1; OR 2.2, 95% CI 1.0-4.7).
Conclusions:
The association between endovascular reperfusion and better clinical outcomes is more profound in patients with ICA and proximal MCA occlusions compared to patients with distal MCA occlusions. Because there are limited data from randomized controlled trials on the effect of endovascular therapy in patients with distal MCA occlusions, these results underscore the need for inclusion of this subgroup in future endovascular therapy trials.
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