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

Area of Science:

• Neurology
• Interventional Radiology
• Vascular Medicine

Background:

• Endovascular thrombectomy (EVT) trials for medium vessel occlusion (MeVO) show mixed results.
• The impact of device-to-vessel size ratio on MeVO outcomes is not well understood.

Purpose of the Study:

• To investigate the association between the device-to-vessel size ratio and 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 impacts futility and symptomatic intracranial hemorrhage (sICH).

Main Methods:

• Retrospective single-center observational 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 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).
• The majority of patients (58.9%) were in Group A (ratio ≤1.0).

Conclusions:

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