O-003 Publishing endovascular treatment of M2 medium vessel occlusions - outcomes by frontline technique in the stroke thrombectomy and aneurysm registry

M Gaub; R Abo Kasem; I Maier; A Rai; P Jabbour; J Kim; B Howard; A Alawieh; S Quintero Wolfe; R Starke; M Psychogios; A Shaban; N Goyal; J Dye; A Alaraj; M Ezzeldin; S Yoshimura; D Fiorella; O Tanweer; D Romano; P Navia; H Cuellar; I Fragata; A Polifka; J Osbun; F Siddiqui; M Moss; K Limaye; M Mokin; C Matouk; M Park; W Brinjikji; E Daglioglu; R Williamson; D Altschul; W Casagrande; C Ogilvy; R Crosa; M Levitt; B Gory; S Chowdhry; A Paul; P Kan; M Stiefel; R Grandhi; A Spiotta; J Mascitelli

doi:10.1136/jnis-2025-SNIS.3

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O-003 Publishing endovascular treatment of M2 medium vessel occlusions - outcomes by frontline technique in the stroke thrombectomy and aneurysm registry

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O-003 Publishing endovascular treatment of M2 medium vessel occlusions - outcomes by frontline technique in the stroke thrombectomy and aneurysm registry

M Gaub, R Abo Kasem, I Maier, A Rai, P Jabbour, J Kim, B Howard, A Alawieh, S Quintero Wolfe, R Starke, …

Journal of neurointerventional surgery, Vol.17(Suppl 1), pp.A2-A4

07/01/2025

DOI: 10.1136/jnis-2025-SNIS.3

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Abstract

Introduction/PurposeRecent thrombectomy trials have furthered uncertainty regarding endovascular benefit for distal and middle vessel occlusions (DMVOs). Stent retrievers were employed in first-attempt approaches in the majority of ESCAPE-MeVO and DISTAL interventional arm participants. We sought to compare efficacy and safety outcomes in acute MCA M2 segment occlusions between frontline aspiration and stent retriever mechanical thrombectomy (MT) techniques.Materials and MethodsRetrospective analysis of a multicenter, multinational stroke thrombectomy cohort identified cases of MT for acute M2 DMVO. Unmatched and propensity score-matched (PSM) cohorts comparing a direct aspiration first pass technique (ADAPT) to standalone and combined stent-retriever (SR) approaches were generated. The primary outcome was functional independence (mRS 0–2) at 90 days. Recanalization, symptomatic intracranial hemorrhage (sICH), 90-day mortality, and the effect of M2 laterality and segment occlusion were secondarily assessed.ResultsBetween January 2013 and June 2024, 1,734 patients with M2 occlusions underwent ADAPT (n=711) or SR/combined (n=958) frontline thrombectomy. Cohort demographics were 51.1% female, mean age 70.6 +/- 14 years, with median admission NIHSS 13 (IQR 7–18) and ASPECTS 8 (IQR 8–10), and left M2 involvement in 63.4%. Overall functional independence was 46.5%, successful recanalization (mTICI ≥2b) 88.5%, sICH 4.7%, and mortality 19.6%. Univariate analysis by frontline technique showed higher rates of functional independence (49.5% vs. 44.1%; OR 1.24 [1.02–1.51]), complete recanalization (mTICI ≥2c, 60.8% vs. 47.4%; OR 1.72 [95 CI% 1.42–2.09]), and true first pass success (mTICI ≥2c with one MT attempt, 34.4% vs. 26.8%; OR 1.43 [1.16–1.76]) favoring ADAPT. PSM cohorts (ADAPT vs. SR/combined, n = 711) were balanced except for lower procedure time with ADAPT (28 [15–49.5] minutes vs 51 [35–78] minutes; p < 0.001). PSM analysis favored ADAPT for functional independence (49.9% vs. 44.0%, OR 1.27 [1.03–1.57]), complete recanalization (61.2% vs. 48.7%, OR 1.66 [1.34–2.05]), and true first pass success (35.0% vs. 27.6%, OR 1.42 [1.13–1.78]). ADAPT had lower rates of sICH (3.5 vs. 6.2%, OR 0.55 [0.33–0.91]) with no difference in mortality (19.1% vs. 17.9%, OR 1.09 [0.83–1.42]). Left M2 occlusions showed higher odds of functional independence (OR 1.37 [1.08–1.73]) and complete recanalization (OR 1.39 [1.10–1.75]), with lower odds of futile recanalization (90-day mRS 3 after a post-procedure mTICI scale ≥2b, OR 0.74 [0.59–0.94]).ConclusionFrontline ADAPT technique for M2 occlusions resulted in better clinical and angiographic outcomes compared to SRs. Future trials for DMVOs with a focus on aspiration thrombectomy may succeed where recent trials have failed.Abstract O-003 Figure 1DisclosuresM. Gaub: None. R. Abo Kasem: None. I. Maier: 6; C; Pfizer, Bristol-Myers Squibb. A. Rai: None. P. Jabbour: None. J. Kim: None. B. Howard: None. A. Alawieh: 1; C; Department of Defense, Abbott. S. Quintero Wolfe: None. R. Starke: 1; C; NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant, NIH, National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities, Medtronic and Balt. 2; C; Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular.. M. Psychogios: 1; C; Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Bangerter-Rhyner Stiftung for the DISTAL trial, Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc, Siemens Healthineers AG. 2; C; Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. A. Shaban: None. N. Goyal: None. J. Dye: None. A. Alaraj: 2; C; Cerenovus. M. Ezzeldin: 2; C; Viz.ai, Imperative care. 6; C; Galaxy Therapeutics. S. Yoshimura: 3; C; lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics.. D. Fiorella: None. O. Tanweer: 1; C; Grants: Q’apel Inc, Steinberg Foundation. 2; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc.. 6; C; Proctor: Microvention Inc, Medtronic Inc. D. Romano: 2; C; Consultant for Penumbra, Balt, Microvention, Phenox. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. I. Fragata: None. A. Polifka: None. J. Osbun: None. F. Siddiqui: None. M. Moss: None. K. Limaye: None. M. Mokin: None. C. Matouk: 2; C; Consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical.. 3; C; Speaker for Penumbra and Silk Road Medical.. 6; C; Contact PI for NIH Grant R21NS128641. M. Park: 2; C; Consultant for Medtronic. W. Brinjikji: 2; C; consulting fees from Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt.. 4; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular.. 6; C; royalties from Medtronic and Balloon Guide Catheter Technology., leadership or fiduciary role for MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, and WFITN.. E. Daglioglu: None. R. Williamson Jr: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. D. Altschul: 2; C; Consultant for MicroVention, Stryker, and Cerenovus. W. Casagrande: None. C. Ogilvy: None. R. Crosa: None. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker. 2; C; consulting agreement with Medtronic, Aeaean Advisers, Metis Innovative, and Genomadix;. 4; C; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical. 6; C; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Arsenal Medical.. B. Gory: None. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. A. Paul: None. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens.. 2; C; Consultant for Imperative Care and Stryker Neurovascular.. 4; C; Stock ownership in Vena Medical.. M. Stiefel: None. R. Grandhi: 2; C; Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, Stryker Neurovascular. A. Spiotta: 2; C; Penumbra, Terumo. J. Mascitelli: 1; C; Bee Foundation, Joe Niekro Foundation, Mizuho. 2; C; Stryker, Imperative Care Site.

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Title: Subtitle: O-003 Publishing endovascular treatment of M2 medium vessel occlusions - outcomes by frontline technique in the stroke thrombectomy and aneurysm registry
Creators: M Gaub - The University of Texas Health Science Center at San Antonio
R Abo Kasem - Medical University of South Carolina
I Maier - Universitätsmedizin Göttingen
A Rai - West Virginia University
P Jabbour - Thomas Jefferson University
J Kim - Chonnam National University Hospital
B Howard - Emory University
A Alawieh - Emory University
S Quintero Wolfe - Atrium Health Wake Forest Baptist
R Starke - University of Miami Health System
M Psychogios - University Hospital of Basel
A Shaban - University of Iowa
N Goyal - Semmes Murphey Foundation
J Dye - Loma Linda University
A Alaraj - University of Chicago
M Ezzeldin
S Yoshimura - Hyogo Medical University
D Fiorella - Stony Brook University
O Tanweer - Baylor College of Medicine
D Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona
P Navia - Hospital Universitario La Paz
H Cuellar - Louisiana State University Health Sciences Center Shreveport
I Fragata - Unidade Local de Saúde de São José
A Polifka - University of Florida
J Osbun - Washington University in St. Louis
F Siddiqui - West Health
M Moss - Washington Regional Medical Center
K Limaye - Indiana University Bloomington
M Mokin - University of South Florida
C Matouk - Yale University
M Park - University of Virginia
W Brinjikji - Mayo Clinic
E Daglioglu
R Williamson - Allegheny Health Network
D Altschul - Montefiore Medical Center
W Casagrande - Hospital Fernández
C Ogilvy - Beth Israel Deaconess Medical Center
R Crosa - Administracion de los Servicios de Salud del Estado
M Levitt - University of Washington
B Gory
S Chowdhry - NorthShore University HealthSystem
A Paul - Albany Medical Center Hospital
P Kan - The University of Texas Medical Branch at Galveston
M Stiefel - Piedmont HealthCare
R Grandhi - University of Utah
A Spiotta - Medical University of South Carolina
J Mascitelli - The University of Texas Health Science Center at San Antonio
Resource Type: Abstract
Publication Details: Journal of neurointerventional surgery, Vol.17(Suppl 1), pp.A2-A4
DOI: 10.1136/jnis-2025-SNIS.3
ISSN: 1759-8478
eISSN: 1759-8486
Publisher: BMJ Publishing Group LTD
Language: English
Date published: 07/01/2025
Academic Unit: Neurology
Record Identifier: 9984845452002771

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