3 research outputs found
LongâTerm Stability of Patients Undergoing Endovascular Parent Artery Occlusion of Their Intracranial Artery
Background Although endovascular parent artery occlusion (PAO) of the intracranial artery is a wellâestablished treatment option, the longâterm stability of cerebral blood flow remains a concern. This study aimed to evaluate the longâterm clinical and radiological outcomes of patients who underwent PAO. Methods The patients who underwent endovascular PAO of their internal carotid or vertebral artery (VA) between April 2011 and March 2022 were included in this observational study. Information about patient characteristics, details of the endovascular treatment, and clinical and radiological followâup were collected. Results The study included a total of 104 cases (average age, 52.9±12.6 years old; men, 73 [70.2%] cases; 95 [91.3%] VA PAO cases) from 8 centers. Most cases were performed in an emergency condition, such as ruptured VA dissecting aneurysm (73 cases [70.2%]). PAO was successful in all cases. Early stroke (within 30 days) occurred in 33 (31.7%) cases (31 cases in VA PAO and 2 cases in internal carotid PAO) with ischemic stroke (29 cases) comprising the largest group. Clinical followâup over 1 month was available in 85 cases. During an average followâup period of 45.8±25.8 months, 1 case of VA PAO experienced a stroke without functional deterioration. Imaging followâup was performed in 75 cases. Recanalization of the occluded VA was observed in 2 cases. The remaining image change was contralateral VA stenosis after VA PAO. The incidence of clinical and radiological events was 1.2% and 1.1% per patientâyear, respectively. Conclusion Once the patients surpass the acute phase after PAO, their midâ to longâterm course was stable. The risk of late stroke or de novo aneurysm formation was lower than expected in the literature, and the direct comparison to novel reconstructive techniques is warranted in future studies. Clinical Trial Registration information: https://www.umin.ac.jp/ctr/index.html, trial ID: UMIN000045160
Aspiration Versus StentâRetriever as FirstâLine Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A PropensityâScore Matched Multicenter Analysis
Background For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stentâretriever for firstâline reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to firstâline technique in a large, multicenter registry. Methods Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to firstâline endovascular technique (stentâretriever versus aspiration). Multivariable logistic regression and propensityâscore matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2bâ3 (âsuccessful recanalizationâ), as well as secondary outcomes (firstâpass effect, expanded Thrombolysis in Cerebral Infarction 2câ3, intracerebral hemorrhage, and 90âday modified Rankin scale, 90âday mortality) between treatment groups. Results Of the 440 included patients (44.5% stentâretriever versus 55.5% aspiration), those treated with stentâretriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P<0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11; P=0.02), and nonsignificantly fewer mediumâdistal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%; P=0.10). Use of a stentâretriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74â0.98]; P=0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72â1.09]; P=0.24), or in the propensityâscore matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75â1.18]; P=0.60). There was no significant association between technique and secondary outcomes in the propensityâscore matched adjusted models. Conclusion In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stentâretriever thrombectomy