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Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

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Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study. / Meyer, Lukas; Stracke, Paul; Wallocha, Marta; Broocks, Gabriel; Sporns, Peter; Piechowiak, Eike I; Kaesmacher, Johannes; Maegerlein, Christian; Hernandez Petzsche, Moritz Roman; Dorn, Franziska; Zimmermann, Hanna; Naziri, Weis; Abdullayev, Nuran; Kabbasch, Christoph; Behme, Daniel; Jamous, Ala; Maus, Volker; Fischer, Sebastian; Möhlenbruch, Markus; Weyland, Charlotte S; Langner, Sönke; Meila, Dan; Miszczuk, Milena; Siebert, Eberhard; Lowens, Stephan; Krause, Lars Udo; Yeo, Leonard; Tan, Benjamin; Gopinathan, Anil; Gory, Benjamin; Galván-Fernández, Jorge; Schüller, Miguel; Navia, Pedro; Raz, Eytan; Shapiro, Maksim; Arnberg, Fabian; Zeleňák, Kamil; Martínez-Galdámez, Mario; Kastrup, Andreas; Papanagiotou, Panagiotis; Kemmling, André; Psychogios, Marios; Andersson, Tommy; Chapot, Rene; Fiehler, Jens; Hanning, Uta; TOPMOST Study Group.

In: STROKE, Vol. 53, No. 8, 08.2022, p. 2449-2457.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Meyer, L, Stracke, P, Wallocha, M, Broocks, G, Sporns, P, Piechowiak, EI, Kaesmacher, J, Maegerlein, C, Hernandez Petzsche, MR, Dorn, F, Zimmermann, H, Naziri, W, Abdullayev, N, Kabbasch, C, Behme, D, Jamous, A, Maus, V, Fischer, S, Möhlenbruch, M, Weyland, CS, Langner, S, Meila, D, Miszczuk, M, Siebert, E, Lowens, S, Krause, LU, Yeo, L, Tan, B, Gopinathan, A, Gory, B, Galván-Fernández, J, Schüller, M, Navia, P, Raz, E, Shapiro, M, Arnberg, F, Zeleňák, K, Martínez-Galdámez, M, Kastrup, A, Papanagiotou, P, Kemmling, A, Psychogios, M, Andersson, T, Chapot, R, Fiehler, J, Hanning, U & TOPMOST Study Group 2022, 'Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study', STROKE, vol. 53, no. 8, pp. 2449-2457. https://doi.org/10.1161/STROKEAHA.121.037792

APA

Meyer, L., Stracke, P., Wallocha, M., Broocks, G., Sporns, P., Piechowiak, E. I., Kaesmacher, J., Maegerlein, C., Hernandez Petzsche, M. R., Dorn, F., Zimmermann, H., Naziri, W., Abdullayev, N., Kabbasch, C., Behme, D., Jamous, A., Maus, V., Fischer, S., Möhlenbruch, M., ... TOPMOST Study Group (2022). Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study. STROKE, 53(8), 2449-2457. https://doi.org/10.1161/STROKEAHA.121.037792

Vancouver

Meyer L, Stracke P, Wallocha M, Broocks G, Sporns P, Piechowiak EI et al. Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study. STROKE. 2022 Aug;53(8):2449-2457. https://doi.org/10.1161/STROKEAHA.121.037792

Bibtex

@article{f0d070be34d742748a618e9effb90b8d,
title = "Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study",
abstract = "BACKGROUND: The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation.METHODS: TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events.RESULTS: A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62-81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; P=0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; P=0.933) and modified Rankin Scale rates (modified Rankin Scale score 0-1, aspiration: 60.5% versus stent retriever 68.6%; P=0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95-0.99]; P<0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16-9.21]; P<0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases.CONCLUSIONS: Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.",
author = "Lukas Meyer and Paul Stracke and Marta Wallocha and Gabriel Broocks and Peter Sporns and Piechowiak, {Eike I} and Johannes Kaesmacher and Christian Maegerlein and {Hernandez Petzsche}, {Moritz Roman} and Franziska Dorn and Hanna Zimmermann and Weis Naziri and Nuran Abdullayev and Christoph Kabbasch and Daniel Behme and Ala Jamous and Volker Maus and Sebastian Fischer and Markus M{\"o}hlenbruch and Weyland, {Charlotte S} and S{\"o}nke Langner and Dan Meila and Milena Miszczuk and Eberhard Siebert and Stephan Lowens and Krause, {Lars Udo} and Leonard Yeo and Benjamin Tan and Anil Gopinathan and Benjamin Gory and Jorge Galv{\'a}n-Fern{\'a}ndez and Miguel Sch{\"u}ller and Pedro Navia and Eytan Raz and Maksim Shapiro and Fabian Arnberg and Kamil Zele{\v n}{\'a}k and Mario Mart{\'i}nez-Gald{\'a}mez and Andreas Kastrup and Panagiotis Papanagiotou and Andr{\'e} Kemmling and Marios Psychogios and Tommy Andersson and Rene Chapot and Jens Fiehler and Uta Hanning and {TOPMOST Study Group}",
year = "2022",
month = aug,
doi = "10.1161/STROKEAHA.121.037792",
language = "English",
volume = "53",
pages = "2449--2457",
journal = "STROKE",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

RIS

TY - JOUR

T1 - Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

AU - Meyer, Lukas

AU - Stracke, Paul

AU - Wallocha, Marta

AU - Broocks, Gabriel

AU - Sporns, Peter

AU - Piechowiak, Eike I

AU - Kaesmacher, Johannes

AU - Maegerlein, Christian

AU - Hernandez Petzsche, Moritz Roman

AU - Dorn, Franziska

AU - Zimmermann, Hanna

AU - Naziri, Weis

AU - Abdullayev, Nuran

AU - Kabbasch, Christoph

AU - Behme, Daniel

AU - Jamous, Ala

AU - Maus, Volker

AU - Fischer, Sebastian

AU - Möhlenbruch, Markus

AU - Weyland, Charlotte S

AU - Langner, Sönke

AU - Meila, Dan

AU - Miszczuk, Milena

AU - Siebert, Eberhard

AU - Lowens, Stephan

AU - Krause, Lars Udo

AU - Yeo, Leonard

AU - Tan, Benjamin

AU - Gopinathan, Anil

AU - Gory, Benjamin

AU - Galván-Fernández, Jorge

AU - Schüller, Miguel

AU - Navia, Pedro

AU - Raz, Eytan

AU - Shapiro, Maksim

AU - Arnberg, Fabian

AU - Zeleňák, Kamil

AU - Martínez-Galdámez, Mario

AU - Kastrup, Andreas

AU - Papanagiotou, Panagiotis

AU - Kemmling, André

AU - Psychogios, Marios

AU - Andersson, Tommy

AU - Chapot, Rene

AU - Fiehler, Jens

AU - Hanning, Uta

AU - TOPMOST Study Group

PY - 2022/8

Y1 - 2022/8

N2 - BACKGROUND: The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation.METHODS: TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events.RESULTS: A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62-81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; P=0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; P=0.933) and modified Rankin Scale rates (modified Rankin Scale score 0-1, aspiration: 60.5% versus stent retriever 68.6%; P=0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95-0.99]; P<0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16-9.21]; P<0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases.CONCLUSIONS: Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.

AB - BACKGROUND: The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation.METHODS: TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events.RESULTS: A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62-81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; P=0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; P=0.933) and modified Rankin Scale rates (modified Rankin Scale score 0-1, aspiration: 60.5% versus stent retriever 68.6%; P=0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95-0.99]; P<0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16-9.21]; P<0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases.CONCLUSIONS: Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.

U2 - 10.1161/STROKEAHA.121.037792

DO - 10.1161/STROKEAHA.121.037792

M3 - SCORING: Journal article

C2 - 35443785

VL - 53

SP - 2449

EP - 2457

JO - STROKE

JF - STROKE

SN - 0039-2499

IS - 8

ER -