Angiographic Systems for Classifying Distal Arterial Occlusions.

Area of Science:

• Neurology
• Interventional Radiology
• Vascular Medicine

Background:

• Randomized controlled trials (RCTs) for anterior circulation large vessel occlusions are established.
• RCTs for distal arterial occlusions are lacking, hindering optimal treatment strategies.
• Clear definitions and classifications are crucial for designing effective distal occlusion RCTs.

Approach:

• Systematic literature review of 70 articles on distal arterial occlusions.
• Analysis of existing classification systems: classical/anatomical, functional/imaging, and structural/calibre.
• Comparison of similarities and differences between classification methods.

Key Points:

• Propose functional/imaging classification for distal arterial occlusions.
• Define M2 segment starting at the middle cerebral artery trunk/M1 bifurcation.
• Classify anterior temporal artery as M1 branch unless holo-temporal, then M2.

Conclusions:

• Functional/imaging classification offers a practical approach for time-critical decisions.
• Standardized nomenclature will facilitate robust RCT design for distal occlusions.
• Improved classification can enhance patient selection and outcomes in endovascular therapy.