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Updated: May 12, 2026
Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
Left-Sided Anterior Distribution Large Vessel Occlusion with Thrombectomy Is Associated with Worse Clinical Outcome
Jase L Howell1, Akash S Agrawal1, Arjun Agrawal1
1Department of Neurointerventional Radiology, Goodman Campbell Brain and Spine at Ascension St. Vincent Hospital, Indianapolis, Indiana, USA.
Background:
Mechanical thrombectomy is first-line therapy for ischemic stroke in the context of large vessel occlusion. Ninety-day modified Rankin Score (mRS) is a common primary outcome measure. While prior studies are inconsistent with respect to the association between laterality and outcome, functional hemispheric differences are likely to impact presentation and recovery.
Methods:
We analyzed a retrospective database of consecutive thrombectomy patients treated between 2011 and 2020 in a high-volume single practice. Patients with posterior distribution strokes were excluded. Data included 90-day mRS, baseline National Institutes of Health Stroke Scale, final modified thrombolysis in cerebral infarction (mTICI), demographics, occlusion site, and laterality. Complete case analysis used chi-square tests for categorical/ordinal variables, nonparametric tests for continuous variables, and multivariate regression to adjust for covariates.
Results:
Of 1047 patients, 956 were included in the left-sided versus right-sided occlusion analysis. Ninety-day mRS differed by laterality (P = 0.044), while mTICI did not (P = 0.482). Baseline National Institutes of Health Stroke Scale was higher for left-sided strokes (P < 0.001). Puncture-to-recanalization (PTR) was longer on the left (P = 0.001). PTR distributions demonstrated an early peak at 15 minutes for both hemispheres, with greater representation of left-sided cases at longer procedural times. Multivariate regression confirmed that age, mTICI ≥2B, and shorter PTR were associated with good outcome (mRS 0-2).
Conclusions:
Stroke laterality is associated with differences in functional outcome following thrombectomy. This relationship is likely multifactorial, reflecting the influence of hemispheric eloquence, baseline clinical severity, and procedural factors such as PTR. Anticipating access complexity and optimizing procedural strategies may help reduce delays and improve outcomes.
