Journal article
The effect of occlusion location and technique in mechanical thrombectomy for minor stroke
Interventional neuroradiology, Vol.32(2), pp.152-161
04/2026
DOI: 10.1177/15910199231196451
PMCID: PMC13100403
PMID: 37593806
Abstract
Introduction Endovascular mechanical thrombectomy (MT) is an established treatment for large vessel occlusion strokes with a National Institutes of Health Stroke Scale (NIHSS) score of 6 or higher. Data pertaining to minor strokes, medium, or distal vessel occlusions, and most effective MT technique is limited and controversial. Methods A multicenter retrospective study of all patients treated with MT presenting with NIHSS score of 5 or less at 29 comprehensive stroke centers. The cohort was dichotomized based on location of occlusion (proximal vs. distal) and divided based on MT technique (direct aspiration first-pass technique [ADAPT], stent retriever [SR], and primary combined [PC]). Outcomes at discharge and 90 days were compared between proximal and distal occlusion groups, and across MT techniques. Results The cohort included 759 patients, 34% presented with distal occlusion. Distal occlusions were more likely to present with atrial fibrillation (p = 0.008) and receive IV tPA (p = 0.001). Clinical outcomes at discharge and 90 days were comparable between proximal and distal groups. Compared to SR, patients managed with ADAPT were more likely to have a modified Rankin Scale of 0–2 at discharge and at 90 days (p = 0.024 and p = 0.013). Primary combined compared to ADAPT, prior stroke, multiple passes, older age, and longer procedure time were independently associated with worse clinical outcome, while successful recanalization was positively associated with good clinical outcomes. Conclusions Proximal and distal occlusions with low NIHSS have comparable outcomes and safety profiles. While all MT techniques have a similar safety profile, ADAPT was associated with better clinical outcomes at discharge and 90 days.
Details
- Title: Subtitle
- The effect of occlusion location and technique in mechanical thrombectomy for minor stroke
- Creators
- Isaac Josh Abecassis - University of LouisvilleEyad Almallouhi - Medical University of South CarolinaReda M. Chalhoub - Medical University of South CarolinaAhmed Helal - University of LouisvilleJanki R. Naidugari - University of LouisvilleSami Al Kasab - Medical University of South CarolinaEric Bass - Medical University of South CarolinaDale Ding - University of LouisvilleVasu Saini - University of MiamiJoshua D. Burks - University of MiamiIlko L. Maier - Department of Neurology, University Medicine Göttingen, Gottingen, GermanyPascal Jabbour - Thomas Jefferson UniversityJoon-Tae Kim - Chonnam National University HospitalStacey Wolfe - Wake Forest UniversityAnsaar Rai - Department of Radiology, West Virginia School of Medicine, Morgantown, WV, USAMarios-Nikos Psychogios - University Hospital of BaselEdgar Samaniego - University of IowaAdam S. Arthur - University of Tennessee Health Science CenterShinichi Yoshimura - Hyogo Medical UniversityBrian Howard - Emory University School of MedicineAli Alawieh - Emory University School of MedicineIsabel Fragata - Neuroradiology Department, Hospital São José Centro Hospitalar, Lisboa, PortugalHugo Cuellar - Department of Neurosurgery, Louisiana State University Health, Shreveport, LA, USAAdam Polifka - Department of Neurosurgery, University of Florida, Gainesville, FL, USAJustin Mascitelli - The University of Texas at San Antonio Health Science CenterJoshua Osbun - Department of Neurosurgery, Washington University of School of Medicine, St. Louis, MO, USARoberto Crosa - Department of Neurosurgery, Endovascular Neurological Center, Montevideo, UruguayCharles Matouk - Yale School of MedicineMin S. Park - University of VirginiaMichael R. Levitt - University of WashingtonTravis Dumont - University of ArizonaRichard W. Williamson - Allegheny Health NetworkAlejandro M. Spiotta - Medical University of South CarolinaRobert M. Starke - University of Miami
- Resource Type
- Journal article
- Publication Details
- Interventional neuroradiology, Vol.32(2), pp.152-161
- DOI
- 10.1177/15910199231196451
- PMID
- 37593806
- PMCID
- PMC13100403
- NLM abbreviation
- Interv Neuroradiol
- ISSN
- 1591-0199
- eISSN
- 2385-2011
- Publisher
- Sage
- Language
- English
- Electronic publication date
- 08/18/2023
- Date published
- 04/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984459413702771
Metrics
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