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Stent Retriever Thrombectomy in Different Thrombus Locations of Anterior Cerebral Circulation

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Abstract

Background

Mechanical thrombectomy (MT) is a safe and efficient treatment for acute ischemic stroke in patients with proximal anterior occlusion and large penumbra. We evaluated the technical and clinical success of MT in relation to the location of the occlusion (internal carotid artery, M1 and M2 segments of the middle cerebral artery).

Methods

We prospectively reviewed 130 patients of whom 105 met the inclusion criteria. Baseline clinical, procedural and imaging variables, technical outcome (TICI, thrombolysis in cerebral infarction), 24 h imaging outcome and three-month clinical outcome (mRS, modified Rankin Scale) were recorded. Differences between the groups were studied with statistical tests according to the type of the variable.

Results

There were 37, 46 and 22 patients in the internal carotid artery (ICA), M1 and M2 groups, respectively. TICI 2b or 3 was achieved in 92 cases (88 %) with a non-significant trend towards a better recanalization outcome in the ICA and M1 groups. Overall, 57 of the 105 patients (55 %) experienced favorable clinical outcome (mRS ≤ 2) with no significant differences between the groups. Excellent outcome (mRS ≤ 1) was seen in 40 patients (39 %) and there proportionally more patients with excellent outcome in the ICA and M1 groups (ICA: 44 %, M1: 41 %, M2: 23 % of patients, p = 0.22).

Conclusions

There were no statistically significant differences in the technical or clinical outcomes between the different sites of occlusion (ICA, M1 or M2). There was a non-significant trend towards achieving excellent clinical outcome (3-month mRS ≤ 1) more often and better recanalization results in the two more proximal locations.

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Abbreviations

ASPECTS:

Alberta Stroke Program Early CT Score

CBV:

Cerebral blood volume

COED:

Cerebral oedema

ICA:

Internal carotid artery

IV:

Intravenous

MCA:

Middle cerebral artery

MT:

Mechanical thrombectomy

MTT:

Mean transit time

NIHSS:

National Institutes of Health Stroke Scale

TICI:

Thrombolysis in cerebral infarction

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Acknowledgments

The authors would like to thank Jyrki Ollikainen, MD, for clinical insights in preparing the manuscript. This study was financially supported by the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital (Grant 9S061).

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Authors and Affiliations

  1. Department of Neurology, Tampere University Hospital, Tampere, Finland

    Heikki Numminen

  2. Medical Imaging Center, Tampere University Hospital, PL 2000, 33521, Tampere, Finland

    Sara Protto, Niko Sillanpää, Juha-Pekka Pienimäki, Ira Matkaselkä & Janne Seppänen

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  1. Sara Protto
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  2. Niko Sillanpää
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Correspondence to Niko Sillanpää.

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All authors declare that they have no conflicts of interest relevant to this manuscript.

Ethical Standards

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Protto, S., Sillanpää, N., Pienimäki, JP. et al. Stent Retriever Thrombectomy in Different Thrombus Locations of Anterior Cerebral Circulation. Cardiovasc Intervent Radiol 39, 988–993 (2016). https://doi.org/10.1007/s00270-016-1315-4

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  • DOI: https://doi.org/10.1007/s00270-016-1315-4

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