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Thrombectomy for medium-sized cerebral vessel occlusion: Size does matter.

Pekka Virtanen1, Silja Räty2, Liisa Tomppo2

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Using a larger endovascular thrombectomy device than the occluded medium vessel increases risks of complications and futile outcomes in stroke patients. Careful device selection is crucial for better treatment results.

Keywords:
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Area of Science:

  • Neurology
  • Interventional Radiology
  • Vascular Surgery

Background:

  • Endovascular thrombectomy (EVT) trials for medium vessel occlusion (MeVO) show mixed results, suggesting potential futility.
  • The influence of device-to-vessel size ratio on MeVO outcomes remains unclear.

Purpose of the Study:

  • To investigate the impact of the device-to-vessel size ratio on outcomes in EVT for M2 segment middle cerebral artery occlusions.
  • To determine if a larger size difference between the thrombectomy device and the occluded vessel correlates with adverse events.

Main Methods:

  • Retrospective single-center study of 146 EVT-treated patients with M2 occlusions.
  • Patients categorized into three groups based on device-to-vessel size ratio (≤1.0, 1.0-1.2, >1.2).
  • Primary outcomes: futility (modified Rankin Scale 5-6 at 3 months) and symptomatic intracranial hemorrhage (sICH).

Main Results:

  • Group C (ratio >1.2) showed higher rates of sICH (20.0%) and futility (34.2%) compared to other groups.
  • Adjusted analyses revealed that belonging to Group C was significantly associated with sICH (OR 3.32) and futility (OR 2.84).

Conclusions:

  • The device-to-vessel size ratio is a critical factor in EVT for MeVO.
  • Larger relative device size is linked to increased risk of hemorrhagic complications and futile outcomes.
  • Optimizing device selection based on vessel size may improve EVT efficacy and safety in MeVO.