Related Experiment Video
Updated: Jul 10, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Safety and efficacy of endovascular thrombectomy for primary and secondary MeVO
Angelo Cascio Rizzo1, Ghil Schwarz1, Amedeo Cervo2
1Department of Neurology and Stroke Unit - ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Background:
Medium-vessel occlusions (MeVO) are emerging as a new target for endovascular treatment (EVT). Primary MeVO occur de novo, while secondary MeVO arise from large vessel occlusion (LVO) through clot migration or fragmentation - spontaneously, following intravenous thrombolysis or EVT. We aimed to evaluate efficacy and safety of EVT in primary and EVT-induced secondary MeVO.
Methods:
Retrospective single-center study on consecutive EVT-treated acute ischemic stroke, from 2019-to-2021. We considered: (1) exclusive-LVO, patients with LVO and - in case of residual distal occlusion - no rescue endovascular procedure; (2) primary MeVO: initial A2, A3, M2 non-dominant, M3, P2, P3 occlusions; (3) EVT-induced secondary MeVO, presenting LVO with subsequent (treated) EVT-induced MeVO. We compared (univariable/multivariable logistic regression) EVT efficacy (eTICI≥2b, 3-month modified Rankin Scale [mRS] 0-2) and safety (EVT-complications [vessel dissection, perforation, persistent-SAH], symptomatic ICH) in all MeVO versus exclusive-LVO, primary MeVO versus exclusive-LVO, EVT-induced secondary MeVO versus exclusive-LVO and EVT-induced secondary MeVO versus primary MeVO.
Results:
We included 335 patients: 221 (66.0 %) exclusive-LVO and 114 (34.0 %) MeVO (55 [48.2 %] primary, 59 [51.8 %] secondary). Compared to exclusive-LVO, primary MeVO had higher rates of EVT complications (aOR 3.77 [95%CI 1.58-9.00],p=0.003), lower rates of eTICI≥2b (aOR 0.32 [95%CI 0.12-0.88],p=0.027) and mRS 0-2 (aOR 0.28 [95%CI 0.13-0.63],p=0.002). EVT-induced secondary MeVO had no major differences in efficacy and safety outcomes compared to exclusive-LVO, but a better mRS 0-2 (aOR 8.00 [95%CI 2.12-30.17],p=0.002) compared to primary MeVO.
Conclusions:
Primary and EVT-induced secondary MeVO showed different safety/efficacy EVT-related profiles. Dedicated randomized data are needed to identify the best acute reperfusion strategy in the two categories.
Insights
Endovascular treatment for medium-vessel occlusions (MeVO) shows varied outcomes. Primary MeVO have higher complication rates, while EVT-induced secondary MeVO demonstrate comparable safety and efficacy to large vessel occlusions.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Medium-vessel occlusions (MeVO) are an emerging target for endovascular treatment (EVT).
- MeVO can be primary (de novo) or secondary, arising from large vessel occlusions (LVO).
- Understanding EVT efficacy and safety in these distinct MeVO types is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of EVT in primary and EVT-induced secondary MeVO.
- To compare outcomes between primary MeVO, secondary MeVO, and exclusive LVO.
Main Methods:
- Retrospective single-center study of EVT-treated acute ischemic stroke patients (2019-2021).
- Categorization into exclusive LVO, primary MeVO, and EVT-induced secondary MeVO.
- Comparison of EVT efficacy (eTICI≥2b, mRS 0-2) and safety (complications, symptomatic ICH) using logistic regression.
Main Results:
- Primary MeVO showed higher EVT complication rates and lower rates of successful reperfusion (eTICI≥2b) and favorable functional outcomes (mRS 0-2) compared to exclusive LVO.
- EVT-induced secondary MeVO had similar efficacy and safety outcomes to exclusive LVO.
- EVT-induced secondary MeVO demonstrated better functional outcomes (mRS 0-2) than primary MeVO.
Conclusions:
- Primary and EVT-induced secondary MeVO exhibit distinct safety and efficacy profiles following EVT.
- Further randomized trials are necessary to optimize acute reperfusion strategies for different MeVO types.
