Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions

Area of Science:

• Neurology
• Interventional Neurology
• Vascular Neurology

Background:

• Simultaneous multivessel occlusions (MVOs) are uncommon during acute ischemic stroke interventions.
• Endovascular thrombectomy (EVT) is a primary treatment for acute ischemic stroke.

Purpose of the Study:

• To determine the prevalence of MVOs in patients undergoing EVT for acute ischemic stroke.
• To identify factors associated with MVOs.
• To analyze the outcomes of patients with MVOs treated with EVT.

Main Methods:

• Retrospective analysis of consecutive patients who underwent EVT for acute ischemic stroke.
• Definition of MVO as simultaneous occlusion of two or more major intracranial or extracranial vessels.
• Analysis of baseline characteristics, MVO causes, EVT procedures, and 90-day outcomes.

Main Results:

• 1.8% of 602 EVT patients had MVOs.
• MVO patients showed higher preadmission dependence, stroke severity, and posterior cerebral artery occlusion.
• Causes included atherosclerosis, cardioembolism, hypercoagulability, and postpartum.
• MVO patients had significantly higher 90-day mortality and poor functional outcomes compared to non-MVO patients.

Conclusions:

• Acute simultaneous MVOs are rare but associated with poor prognosis in acute ischemic stroke patients undergoing EVT.
• Multitarget EVT for MVOs is technically challenging but feasible, though optimal reperfusion is difficult to achieve.