Key result
Embolization to a new vascular territory during thrombectomy is not linked to poorer 90-day outcomes.
Why the study?
Does embolization to a new vascular territory during mechanical thrombectomy worsen 90-day clinical outcomes in patients with medium vessel occlusion stroke?
Cohort (n=2,122)
Yes
Does embolization to a new vascular territory during mechanical thrombectomy worsen 90-day clinical outcomes in patients with medium vessel occlusion stroke?
Embolization to a new territory during mechanical thrombectomy for medium vessel occlusion stroke is infrequent and does not significantly worsen 90-day clinical outcomes, suggesting the risk of ENT should not deter clinicians from performing the procedure.
BACKGROUND: Mechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines the impact of periprocedural embolization to a new vascular territory (ENT) on clinical outcomes in patients with MeVO stroke treated with MT. METHODS: A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke w-ho underwent MT between September 2017 and July 2023. ENT was defined as filling defects in previously unaffected territories, excluding embolization near the original occlusion, observed on final angiographic runs after retrieval of the primary thrombus. The associations between ENT, procedural variables, and 90-day clinical outcomes were evaluated, including functional independence (modified Rankin Scale (mRS) scores of 0-2), excellent outcomes (mRS 0-1), mortality, and hemorrhagic complications. RESULTS: ENT occurred in 2.9% (63/2122) of patients. Longer onset-to-arterial puncture time (adjusted OR 1.03; 95% CI 1.01 to 1.05; P=0.002) and a greater number of passes (adjusted OR 1.15; 95% CI 1.01 to 1.32; P=0.032) were associated with increased ENT risk, while excellent recanalization (thrombolysis in cerebral infarction (TICI) scale score 2c-3) was associated with reduced ENT risk (adjusted OR 0.41; 95% CI 0.23 to 0.72; P=0.002). ENT was not associated with poorer functional independence, mortality, or hemorrhagic complications. CONCLUSIONS: ENT during MT for MeVO stroke occurs infrequently and does not significantly affect the clinical outcomes. These findings suggest ENT risk should not deter clinicians from performing MT in patients with MeVO. Further prospective studies are needed to validate these results.
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Salim et al. (2025) conducted a cohort in Medium vessel occlusion stroke (n=2,122). Embolization to a new vascular territory (ENT) vs. No embolization to a new vascular territory was evaluated on 90-day clinical outcomes including functional independence (mRS 0-2), excellent outcomes (mRS 0-1), mortality, and hemorrhagic complications. Embolization to a new vascular territory occurred in 2.9% (63/2122) of patients and was not associated with poorer 90-day functional independence, mortality, or hemorrhagic complications.
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