Meyer, Lukas ORCID: 0000-0002-3776-638X, Stracke, Christian Paul, Wallocha, Marta, Broocks, Gabriel ORCID: 0000-0002-7575-9850, Sporns, Peter B., Piechowiak, Eike, I, Kaesmacher, Johannes ORCID: 0000-0002-9177-2289, Maegerlein, Christian, Dorn, Franziska, Zimmermann, Hanna, Naziri, Weis, Abdullayev, Nuran, Kabbasch, Christoph, Behme, Daniel, Jamous, Ala, Maus, Volker, Fischer, Sebastian, Moehlenbruch, Markus, Weyland, Charlotte Sabine, Langner, Soenke, Meila, Dan, Miszczuk, Milena, Siebert, Eberhard, Lowens, Stephan, Krause, Lars Udo, Yeo, Leonard L. L., Tan, Benjamin Y. Q., Gopinathan, Anil, Gory, Benjamin, Arenillas, Juan F., Navia, Pedro ORCID: 0000-0002-6516-6090, Raz, Eytan, Shapiro, Maksim, Arnberg, Fabian, Zelenak, Kamil, Martinez-Galdamez, Mario, Kastrup, Andreas, Papanagiotou, Panagiotis, Kemmling, Andre, Psychogios, Marios N., Andersson, Tommy, Chapot, Rene, Fiehler, Jens and Hanning, Uta . Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion. J. NeuroInterventional Surg.. LONDON: BMJ PUBLISHING GROUP. ISSN 1759-8486

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Abstract

Background Whether to approach distal occlusions endovascularly or not in medium-sized vessels secondary to proximal large vessel occlusion stroke remains unanswered. Objective To investigates the technical feasibility and safety of thrombectomy for secondary posterior circulation distal, medium vessel occlusions (DMVO). Methods TOPMOST (Treatment fOr Primary Medium vessel Occlusion STroke) is an international, retrospective, multicenter, observational registry of patients treated for distal cerebral artery occlusions. This study subanalysis endovascularly treated occlusions of the posterior cerebral artery in the P2 and P3 segment secondary preprocedural or periprocedural thrombus migration between January 2014 and June 2020. Technical feasibility was evaluated with the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Procedural safety was assessed by the occurrence of symptomatic intracranial hemorrhage (sICH) and intervention-related serious adverse events. Results Among 71 patients with secondary posterior circulation DMVO who met the inclusion criteria, occlusions were present in 80.3% (57/71) located in the P2 segment and in 19.7% (14/71) in the P3 segment. Periprocedural migration occurred in 54.9% (39/71) and preprocedural migration in 45.1% (32/71) of cases. The first reperfusion attempt led in 38% (27/71) of all cases to mTICI 3. On multivariable logistic regression analysis, increased numbers of reperfusion attempts (adjusted odds ratio (aOR)=0.39, 95% CI 0.29 to 0.88, p=0.009) and preprocedural migration (aOR=4.70, 95% CI,1.35 to 16.35, p=0.015) were significantly associated with mTICI 3. sICH occurred in 2.8% (2/71). Conclusion Thrombectomy for secondary posterior circulation DMVO seems to be safe and technically feasible. Even though thrombi that have migrated preprocedurally may be easier to retract, successful reperfusion can be achieved in the majority of patients with secondary DMVO of the P2 and P3 segment.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Meyer, LukasUNSPECIFIEDorcid.org/0000-0002-3776-638XUNSPECIFIED
Stracke, Christian PaulUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wallocha, MartaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Broocks, GabrielUNSPECIFIEDorcid.org/0000-0002-7575-9850UNSPECIFIED
Sporns, Peter B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Piechowiak, Eike, IUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kaesmacher, JohannesUNSPECIFIEDorcid.org/0000-0002-9177-2289UNSPECIFIED
Maegerlein, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dorn, FranziskaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zimmermann, HannaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Naziri, WeisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abdullayev, NuranUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kabbasch, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Behme, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jamous, AlaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maus, VolkerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fischer, SebastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Moehlenbruch, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weyland, Charlotte SabineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Langner, SoenkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meila, DanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Miszczuk, MilenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Siebert, EberhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lowens, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Krause, Lars UdoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Yeo, Leonard L. L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tan, Benjamin Y. Q.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gopinathan, AnilUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gory, BenjaminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Arenillas, Juan F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Navia, PedroUNSPECIFIEDorcid.org/0000-0002-6516-6090UNSPECIFIED
Raz, EytanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shapiro, MaksimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Arnberg, FabianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zelenak, KamilUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Martinez-Galdamez, MarioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kastrup, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Papanagiotou, PanagiotisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kemmling, AndreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Psychogios, Marios N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Andersson, TommyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chapot, ReneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fiehler, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hanning, UtaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-607255
DOI: 10.1136/neurintsurg-2021-017742
Journal or Publication Title: J. NeuroInterventional Surg.
Publisher: BMJ PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 1759-8486
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ACUTE ISCHEMIC-STROKE; BASILAR ARTERY-OCCLUSION; MECHANICAL THROMBECTOMY; THROMBUS FRAGMENTATION; ENDOVASCULAR TREATMENT; INTRAVENOUS ALTEPLASE; OUTCOMES; THERAPYMultiple languages
Neuroimaging; SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60725

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