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O-014 Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions—insights from STAR
Abstract   Open access   Peer reviewed

O-014 Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions—insights from STAR

N Dabhi, J Kumar, N Ironside, R Kellogg, I Maier, S Al Kasab, P Jabbour, J Kim, S Wolfe, A Rai, …
Journal of neurointerventional surgery, Vol.15(Suppl 1), pp.A12-A12
07/01/2023
DOI: 10.1136/jnis-2023-SNIS.14
url
https://doi.org/10.1136/jnis-2023-SNIS.14View
Published (Version of record) Open Access

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. In a recent systematic review, MT-treated ACA occlusions were associated with similar rates of successful recanalization, decreased rate of long-term good functional outcome, and increased rate of intracranial hemorrhage (ICH) compared to MT-treated internal cerebral artery (ICA) occlusions. However, procedural and clinical outcomes may differ based on whether the occlusion is isolated to the ACA (ie. primary) or occurs in conjunction with other cerebral arteries (ie. secondary). Methods We performed a retrospective review of the STAR database. All patients with MT-treated primary and secondary ACA occlusions were included. Baseline characteristics, procedural outcomes, complications, and clinical outcomes were collected. Primary and secondary ACA occlusions were compared using Mann-Whitney U test and Kruskal-Willis test for continuous variables and chi-square test for categorical variables. Results The study cohort comprised of 270 patients with ACA occlusions (50.7% female, median age 69.4 [56-79]). For ACA occlusions, the overall rate of complications was 9.4%, successful recanalization was 76.3%, poor functional outcome was 76.7%, and 90-day mortality was 38.8%. There were 61 patients with primary ACA occlusion and 209 patients with secondary ACA occlusion. Secondary ACA occlusions had higher rates of distal embolization (30.1% v 14.8%, p=0.04) and intracranial hemorrhage (40.3% v 13.3%, p<0.001). Patients with secondary ACA occlusions also had higher rate of poor functional outcome (ie. mRS 3-6) at 90 days (83.5% v 54.2%, p=0.007). Rate of successful recanalization (73.2% v 77.1%, p=0.7) and mortality at 90 days (33.3% v 40.5%, p=0.7) did not differ between the two groups. Conclusion Clinical and procedural outcomes for MT-treated ACA occlusions can vary based on etiology (ie. primary, secondary). While rate of successful recanalization and 90-day mortality were similar, secondary ACA occlusions were associated with higher rates of morbidity compared to primary ACA occlusions. Our findings demonstrate the need for an established criteria to determine ideal patient and ACA stroke characteristics amendable to MT treatment. Randomized control trials are necessary to further examine differences in outcomes based on etiology of ACA occlusion. Disclosures N. Dabhi: None. J. Kumar: None. N. Ironside: None. R. Kellogg: None. I. Maier: None. S. Al Kasab: None. P. Jabbour: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: None. M. Psychogios: None. A. Shaban: None. A. Arthur: None. S. Yoshimura: None. B. Howard: None. A. Alawieh: None. O. Tanweer: None. J. Mascitelli: None. I. Fragata: None. H. Cuellar: None. A. Polifka: None. J. Osbun: None. R. Crosa: None. C. Matouk: None. M. Levitt: None. W. Brinjikji: None. T. Dumont: None. R. Williamson: None. P. Navia: None. A. Spiotta: None. M. Park: None.
 Clinical outcomes Mortality

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