Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR

Nisha Dabhi, Jeyan Sathia Kumar, Natasha Ironside, Ryan T. Kellogg, Mohammad Mahdi Sowlat, Kazutaka Uchida, Ilko Maier, Sami Al Kasab, Pascal Jabbour, Joon Tae Kim, Stacey Q. Wolfe, Ansaar Rai, Robert M. Starke, Marios Nikos Psychogios, Edgar A. Samaniego, Adam S. Arthur, Shinichi Yoshimura, Hugo Cuellar, Brian M. Howard, Ali AlawiehDaniele G. Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam J. Polifka, Joshua W. Osbun, Roberto Javier Crosa, Charles Matouk, Michael R. Levitt, Waleed Brinjikji, Mark Moss, Travis M. Dumont, Richard Williamson, Pedro Navia, Peter Kan, Reade De Leacy, Shakeel A. Chowdhry, Mohamad Ezzeldin, Alejandro M. Spiotta, Min S. Park

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The safety and efficacy of mechanical thrombectomy (MT) for the treatment of acute anterior cerebral artery (ACA) occlusions have not clearly been delineated. Outcomes may be impacted based on whether the occlusion is isolated to the ACA (primary ACA occlusion) or occurs in conjunction with other cerebral arteries (secondary). Methods: We performed a retrospective review of the multicenter Stroke Thrombectomy and Aneurysm (STAR) database. All patients with MT-treated primary or secondary ACA occlusions were included. Baseline characteristics, procedural outcomes, complications, and clinical outcomes were collected. Primary and secondary ACA occlusions were compared using the Mann-Whitney U test and Kruskal-Willis test for continuous variables and the χ2 test for categorical variables. Results: The study cohort comprised 238 patients with ACA occlusions (49.2% female, median (SD) age 65.6 (16.7) years). The overall rate of successful recanalization was 75%, 90-day good functional outcome was 23%, and 90-day mortality was 35%. There were 44 patients with a primary ACA occlusion and 194 patients with a secondary ACA occlusion. When adjusted for baseline variables, the rates of successful recanalization (68% vs 76%, P=0.27), 90-day good functional outcome (41% vs 19%, P=0.38), and mortality at 90 days (25% vs 38%, P=0.12) did not differ between primary and secondary ACA occlusion groups. Conclusion: Clinical and procedural outcomes are similar between MT-treated primary and secondary ACA occlusions for select patients. Our findings demonstrate the need for established criteria to determine ideal patient and ACA stroke characteristics amenable to MT treatment.

Original languageEnglish
Article numberjnis-2023-020997
JournalJournal of NeuroInterventional Surgery
DOIs
StateAccepted/In press - 2023

Keywords

  • stroke
  • thrombectomy

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