Safety and efficacy of endovascular thrombectomy for primary and secondary MeVO

Angelo Cascio Rizzo; Ghil Schwarz; Amedeo Cervo; Giuditta Giussani; Chiara Ceresa; Antonella Gatti; Fausto De Angeli; Cristina Motto; Angelo Guccione; Rachele Tortorella; Giuseppe Granata; Claudia Rollo; Antonio Macera; Mariangela Piano; Guglielmo Pero; Elio Clemente Agostoni

doi:10.1016/j.jstrokecerebrovasdis.2023.107492

Safety and efficacy of endovascular thrombectomy for primary and secondary MeVO

J Stroke Cerebrovasc Dis. 2024 Jan;33(1):107492. doi: 10.1016/j.jstrokecerebrovasdis.2023.107492. Epub 2023 Nov 21.

Authors

Angelo Cascio Rizzo¹, Ghil Schwarz², Amedeo Cervo³, Giuditta Giussani², Chiara Ceresa², Antonella Gatti², Fausto De Angeli², Cristina Motto², Angelo Guccione², Rachele Tortorella², Giuseppe Granata³, Claudia Rollo³, Antonio Macera³, Mariangela Piano³, Guglielmo Pero³, Elio Clemente Agostoni²

Affiliations

¹ Department of Neurology and Stroke Unit - ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. Electronic address: angelo.casciorizzo@ospedaleniguarda.it.
² Department of Neurology and Stroke Unit - ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
³ Department of Neuroradiology - ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

PMID: 37988832
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107492

Abstract

Background: Medium-vessel occlusions (MeVO) are emerging as a new target for endovascular treatment (EVT). Primary MeVO occur de novo, while secondary MeVO arise from large vessel occlusion (LVO) through clot migration or fragmentation - spontaneously, following intravenous thrombolysis or EVT. We aimed to evaluate efficacy and safety of EVT in primary and EVT-induced secondary MeVO.

Methods: Retrospective single-center study on consecutive EVT-treated acute ischemic stroke, from 2019-to-2021. We considered: (1) exclusive-LVO, patients with LVO and - in case of residual distal occlusion - no rescue endovascular procedure; (2) primary MeVO: initial A2, A3, M2 non-dominant, M3, P2, P3 occlusions; (3) EVT-induced secondary MeVO, presenting LVO with subsequent (treated) EVT-induced MeVO. We compared (univariable/multivariable logistic regression) EVT efficacy (eTICI≥2b, 3-month modified Rankin Scale [mRS] 0-2) and safety (EVT-complications [vessel dissection, perforation, persistent-SAH], symptomatic ICH) in all MeVO versus exclusive-LVO, primary MeVO versus exclusive-LVO, EVT-induced secondary MeVO versus exclusive-LVO and EVT-induced secondary MeVO versus primary MeVO.

Results: We included 335 patients: 221 (66.0 %) exclusive-LVO and 114 (34.0 %) MeVO (55 [48.2 %] primary, 59 [51.8 %] secondary). Compared to exclusive-LVO, primary MeVO had higher rates of EVT complications (aOR 3.77 [95%CI 1.58-9.00],p=0.003), lower rates of eTICI≥2b (aOR 0.32 [95%CI 0.12-0.88],p=0.027) and mRS 0-2 (aOR 0.28 [95%CI 0.13-0.63],p=0.002). EVT-induced secondary MeVO had no major differences in efficacy and safety outcomes compared to exclusive-LVO, but a better mRS 0-2 (aOR 8.00 [95%CI 2.12-30.17],p=0.002) compared to primary MeVO.

Conclusions: Primary and EVT-induced secondary MeVO showed different safety/efficacy EVT-related profiles. Dedicated randomized data are needed to identify the best acute reperfusion strategy in the two categories.

Keywords: Acute stroke; Endovascular treatment; Medium vessel occlusion; Reperfusion; Thrombectomy.

MeSH terms

Brain Ischemia* / therapy
Endovascular Procedures* / adverse effects
Humans
Ischemic Stroke*
Retrospective Studies
Stroke* / diagnosis
Stroke* / therapy
Thrombectomy / adverse effects
Treatment Outcome