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Published on: October 20, 2017
Endovascular treatment of distal medium vessel occlusions using microcatheter aspiration thrombectomy
Dominik Grieb1,2, Björn Greling3, Katharina Schulz1
1Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
Background And Purpose:
Recent studies suggest that endovascular treatment (EVT) in distal medium vessel occlusion (DMVO) stroke is beneficial even beyond middle cerebral artery (MCA) - M2 segment. However, data about aspiration thrombectomy of DMVOs is scarce since common state-of-the-art aspiration catheters are usually too large for small distal intracranial arteries. We report our initial experiences using the microcatheter aspiration thrombectomy (MAT) technique as frontline therapy for acute DMVOs in the MCA territory.
Methods:
We retrospectively analyzed all acute ischemic stroke (AIS) patients that underwent MAT of a primary or secondary DMVO in the M3 or M4 segment between January 2019 and October 2021. Recanalization rates, procedural safety and outcome data were recorded.
Results:
MAT of acute M3 and M4 occlusions was performed in 19 patients with AIS. Six had isolated DMVO strokes, 13 had secondary DMVOs during EVT of a proximal large vessel occlusion. Successful revascularization to DMVO TICI ≥ 2b was achieved in 58% (11/19) with a single pass in all of them. The median National Institutes of Health Strokes Scale (NIHSS) score at admission and discharge was 12 and 3, respectively. 68% (13/19) of the patients had a good clinical outcome at discharge (modified Rankin Scale 0-2). No symptomatic complications related to MAT occurred.
Conclusions:
MAT of DMVOs in the MCA territory is technically feasible and effective. Compared to stent retriever-based thrombectomy in DMVOs the hemorrhagic complication rate appears notably lower. Further studies are needed to validate the benefit of mechanical thrombectomy in the distal intracranial vasculature.
Insights
Microcatheter aspiration thrombectomy (MAT) is a feasible and effective frontline therapy for acute distal medium vessel occlusion (DMVO) stroke in the middle cerebral artery (MCA) territory. This technique shows promising results with a lower hemorrhagic complication rate compared to other methods.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Distal medium vessel occlusion (DMVO) stroke treatment is evolving, with endovascular treatment (EVT) showing promise beyond the M2 segment of the middle cerebral artery (MCA).
- Limited data exists on aspiration thrombectomy for DMVOs due to the small size of distal intracranial arteries and limitations of current aspiration catheters.
Purpose of the Study:
- To evaluate the initial experience and efficacy of microcatheter aspiration thrombectomy (MAT) as a frontline therapy for acute DMVOs in the MCA territory.
- To assess recanalization rates, procedural safety, and clinical outcomes of MAT in patients with M3 or M4 segment occlusions.
Main Methods:
- Retrospective analysis of acute ischemic stroke (AIS) patients who underwent MAT for primary or secondary DMVOs in the M3 or M4 segments between January 2019 and October 2021.
- Data collection included recanalization rates (TICI ≥ 2b), procedural safety, and clinical outcomes (NIHSS, mRS).
Main Results:
- MAT was performed in 19 AIS patients with M3/M4 occlusions (6 isolated DMVOs, 13 secondary DMVOs).
- Successful revascularization (TICI ≥ 2b) was achieved in 58% (11/19) in a single pass.
- Good clinical outcome (mRS 0-2) was observed in 68% (13/19) of patients, with no symptomatic complications related to MAT.
Conclusions:
- Microcatheter aspiration thrombectomy (MAT) is technically feasible and effective for DMVOs in the MCA territory.
- MAT demonstrates a potentially lower hemorrhagic complication rate compared to stent retriever thrombectomy for DMVOs.
- Further research is warranted to confirm the benefits of mechanical thrombectomy in distal intracranial occlusions.
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