Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR
Year: 2023
Type: article
Study design: Observational Study
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 χ 2 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.
Authors: 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 Alawieh, Daniele 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
Institutions: University of Virginia, Medical University of South Carolina, Hyogo Medical University, Universitätsmedizin Göttingen, University of Göttingen, Thomas Jefferson University, Chonnam National University Hospital, Wake Forest University Health Sciences, Wake Forest University, West Virginia University Hospitals, University of Miami, University Hospital of Basel, University of Iowa Hospitals and Clinics, University of Tennessee Health Science Center, Semmes Murphey Foundation, Louisiana State University Health Sciences Center Shreveport, Emory University, AOU San Giovanni di Dio e Ruggi d'Aragona, NYU Langone Health, The University of Texas at San Antonio Health Science Center, Unidade Local de Saúde de São José, University of Florida Health, University of Florida, Washington University in St. Louis, Yale University, University of Washington, Mayo Clinic, Washington Regional Medical Center, University of Arizona, Allegheny Health Network, Hospital Universitario La Paz, The University of Texas Medical Branch at Galveston, Icahn School of Medicine at Mount Sinai, Endeavor Health, University of Houston
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Stryker, Penumbra, Medtronic Foundation
OpenAlex ID: W4388705731