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Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion

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Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion. / Meyer, Lukas; Stracke, Christian Paul; Wallocha, Marta; Broocks, Gabriel; Sporns, Peter B; Piechowiak, Eike I; Kaesmacher, Johannes; Maegerlein, Christian; Dorn, Franziska; Zimmermann, Hanna; Naziri, Weis; Abdullayev, Nuran; Kabbasch, Christoph; Behme, Daniel; Jamous, Ala; Maus, Volker; Fischer, Sebastian; Möhlenbruch, Markus; Weyland, Charlotte Sabine; Langner, Soenke; Meila, Dan; Miszczuk, Milena; Siebert, Eberhard; Lowens, Stephan; Krause, Lars Udo; Yeo, Leonard Ll; Tan, Benjamin Yq; Gopinathan, Anil; Gory, Benjamin; Arenillas, Juan F; Navia, Pedro; Raz, Eytan; Shapiro, Maksim; Arnberg, Fabian; Zeleňák, Kamil; Martínez-Galdámez, Mario; Kastrup, Andreas; Papanagiotou, Panagiotis; Kemmling, Andre; Psychogios, Marios N; Andersson, Tommy; Chapot, René; Fiehler, Jens; Hanning, Uta; TOPMOST Study Group.

In: J NEUROINTERV SURG, Vol. 14, No. 7, 07.2022, p. 654-659.

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

Harvard

Meyer, L, Stracke, CP, Wallocha, M, Broocks, G, Sporns, PB, Piechowiak, EI, Kaesmacher, J, Maegerlein, C, 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, LL, Tan, BY, Gopinathan, A, Gory, B, Arenillas, JF, Navia, P, Raz, E, Shapiro, M, Arnberg, F, Zeleňák, K, Martínez-Galdámez, M, Kastrup, A, Papanagiotou, P, Kemmling, A, Psychogios, MN, Andersson, T, Chapot, R, Fiehler, J, Hanning, U & TOPMOST Study Group 2022, 'Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion', J NEUROINTERV SURG, vol. 14, no. 7, pp. 654-659. https://doi.org/10.1136/neurintsurg-2021-017742

APA

Meyer, L., Stracke, C. P., Wallocha, M., Broocks, G., Sporns, P. B., Piechowiak, E. I., Kaesmacher, J., Maegerlein, C., Dorn, F., Zimmermann, H., Naziri, W., Abdullayev, N., Kabbasch, C., Behme, D., Jamous, A., Maus, V., Fischer, S., Möhlenbruch, M., Weyland, C. S., ... TOPMOST Study Group (2022). Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion. J NEUROINTERV SURG, 14(7), 654-659. https://doi.org/10.1136/neurintsurg-2021-017742

Vancouver

Meyer L, Stracke CP, Wallocha M, Broocks G, Sporns PB, Piechowiak EI et al. Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion. J NEUROINTERV SURG. 2022 Jul;14(7):654-659. https://doi.org/10.1136/neurintsurg-2021-017742

Bibtex

@article{5fc1d39065504cdb87c448ccbd7b96bf,
title = "Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion",
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.",
author = "Lukas Meyer and Stracke, {Christian Paul} and Marta Wallocha and Gabriel Broocks and Sporns, {Peter B} and Piechowiak, {Eike I} and Johannes Kaesmacher and Christian Maegerlein 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 Sabine} and Soenke Langner and Dan Meila and Milena Miszczuk and Eberhard Siebert and Stephan Lowens and Krause, {Lars Udo} and Yeo, {Leonard Ll} and Tan, {Benjamin Yq} and Anil Gopinathan and Benjamin Gory and Arenillas, {Juan F} 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 Andre Kemmling and Psychogios, {Marios N} and Tommy Andersson and Ren{\'e} Chapot and Jens Fiehler and Uta Hanning and {TOPMOST Study Group}",
note = "{\textcopyright} Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2022",
month = jul,
doi = "10.1136/neurintsurg-2021-017742",
language = "English",
volume = "14",
pages = "654--659",
journal = "J NEUROINTERV SURG",
issn = "1759-8478",
publisher = "BMJ PUBLISHING GROUP",
number = "7",

}

RIS

TY - JOUR

T1 - Thrombectomy for secondary distal, medium vessel occlusions of the posterior circulation: seeking complete reperfusion

AU - Meyer, Lukas

AU - Stracke, Christian Paul

AU - Wallocha, Marta

AU - Broocks, Gabriel

AU - Sporns, Peter B

AU - Piechowiak, Eike I

AU - Kaesmacher, Johannes

AU - Maegerlein, Christian

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 Sabine

AU - Langner, Soenke

AU - Meila, Dan

AU - Miszczuk, Milena

AU - Siebert, Eberhard

AU - Lowens, Stephan

AU - Krause, Lars Udo

AU - Yeo, Leonard Ll

AU - Tan, Benjamin Yq

AU - Gopinathan, Anil

AU - Gory, Benjamin

AU - Arenillas, Juan F

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, Andre

AU - Psychogios, Marios N

AU - Andersson, Tommy

AU - Chapot, René

AU - Fiehler, Jens

AU - Hanning, Uta

AU - TOPMOST Study Group

N1 - © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2022/7

Y1 - 2022/7

N2 - 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.

AB - 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.

U2 - 10.1136/neurintsurg-2021-017742

DO - 10.1136/neurintsurg-2021-017742

M3 - SCORING: Journal article

C2 - 34272260

VL - 14

SP - 654

EP - 659

JO - J NEUROINTERV SURG

JF - J NEUROINTERV SURG

SN - 1759-8478

IS - 7

ER -