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Outcomes After Thrombectomy for Primary and Secondary Medium Vessel MCA Occlusions: a Nationwide Registry Study
Björn M Hansen1,2, Emma Hall3,4, Birgitta Ramgren3,4
1Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden. bjorn.hansen@med.lu.se.
Background:
Medium vessel occlusions (MeVO) can be either isolated events (primary), or secondary to thrombus migration from a large vessel occlusion to a medium-sized vessel. Outcomes following endovascular thrombectomy (EVT) in the middle cerebral artery (MCA) may differ between primary and secondary MeVOs. This study aimed to assess the association between primary/secondary MeVOs and clinical outcomes following EVT in a nationwide patient cohort.
Method:
Patients undergoing EVT were included in two Swedish quality registries. Secondary MeVO was defined as distal migration of a solitary thrombus between baseline CT-angiography and EVT, or basal ganglia infarction on postoperative CT in a patient that presented with a single MeVO on baseline CT-angiography. The primary outcome was good 90-day functional outcome (modified Rankin Scale 0-2). Postoperative change in the National Institutes of Health Stroke Scale-score (NIHSS), was a secondary outcome. Successfully revascularized patients (mTICI 2b-3) were compared with non-revascularized patients in exploratory analyzes.
Results:
Of the 5662 EVTs performed in Sweden (2018-2022), 1118 (20%) targeted solitary MCA territory MeVOs, with 819 (73%) being primary and 299 (27%) secondary. Functional outcomes did not differ between the primary and secondary MeVO groups (OR 0.86, CI 95% 0.65-1.14). Likewise, there was no significant difference in postoperative NIHSS scores (0.26, CI 95% -0.71 to 1.24), between groups (p = 0.597). Successful revascularization was associated with increased chance of good functional outcome for both primary (OR 3.77, CI95% 2.28-6.24, p < 0.001) and secondary MeVOs (OR 2.49, CI95% 1.21-5.14, p = 0.013).
Conclusions:
Patients with a single primary or secondary MCA MeVOs have similar EVT outcomes and both groups seem to benefit from recanalization in exploratory analyses. This indicates that that EVT should not be withheld based on primary/secondary MeVO status.
Insights
Outcomes for endovascular thrombectomy (EVT) in medium vessel occlusions (MeVO) of the middle cerebral artery (MCA) are similar for primary and secondary MeVOs. Both patient groups benefit from successful revascularization, suggesting EVT should not be withheld based on MeVO type.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Medium vessel occlusions (MeVO) can be primary or secondary to thrombus migration.
- Outcomes may differ between primary and secondary MeVOs after endovascular thrombectomy (EVT).
- This study investigates the association between MeVO type and clinical outcomes following EVT.
Purpose of the Study:
- To assess the association between primary and secondary MeVOs and clinical outcomes after EVT.
- To compare functional outcomes and NIHSS scores between primary and secondary MeVO groups.
- To evaluate the benefit of successful revascularization in both MeVO types.
Main Methods:
- Included patients undergoing EVT from Swedish quality registries.
- Defined secondary MeVO by thrombus migration or postoperative CT findings.
- Assessed 90-day functional outcome (mRS 0-2) and NIHSS score changes.
- Compared revascularized (mTICI 2b-3) with non-revascularized patients.
Main Results:
- 1118 of 5662 EVTs targeted MCA MeVOs; 73% were primary, 27% secondary.
- No significant difference in functional outcomes (OR 0.86) or NIHSS scores between primary and secondary MeVO groups.
- Successful revascularization improved outcomes in both primary (OR 3.77) and secondary (OR 2.49) MeVOs.
Conclusions:
- Patients with primary or secondary MCA MeVOs have similar EVT outcomes.
- Both groups appear to benefit from recanalization.
- EVT should not be withheld based on primary/secondary MeVO status.
