Internal Carotid Artery Terminus Occlusions are Associated with Total Recanalization in Mechanical Thrombectomy as Compared to M1 Bifurcation Occlusions. (16th November 2020)

• Record Type: Journal Article
• Authors: Scullen, Tyler; Zeoli, Tyler; Carr, Christopher; Mathkour, Mansour H; Amenta, Peter S; Dumont, Aaron S; Nerva, John D
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_378
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Perioperative care continues to advance with endovascular thrombectomy(EVT) in emergent treatment of acute ischemic stroke(AIS) caused by large vessel occlusion (LVO). Recent literature suggests that odds of successful recanalization decrease with increasing distance from the internal carotid artery bifurcation(ICA). METHODS: Patients treated at our comprehensive stroke center with EVT for non-tandem, non-dissecting LVO from January 2015 to February 2020 were retrospectively reviewed (n = 286). LVO locations other than the ICA terminus or distal M1 segment were excluded (n = 254). Outcome values of the NIHSS, modified Rankin score at discharge(mRS), TICI score, and discharge dispositions were recorded. Good functional outcomes was defined as mRS < 3 at discharge. RESULTS: A total of 32 patients were reviewed. There was no significant difference in patient mortality, admission NIHSS, or age between groups. Patients with ICA terminus LVO(n = 11) had a significant higher percentage of TICI 3 recanalization as compared to distal M1(n = 21) LVO (90.9vs.30.1, P = . 0047) and increased likelihood of total recanalization (OR = 10, 95%CI:1.03-97.5, P = . 0475). There was a higher percentage of successful recanalization (TICI 3/2B) among terminus occlusions(100%vs.76%), but this did not reach significance ( P = . 0820). There were no significant differences in good functional outcome or home disposition between groups. CONCLUSION: Perioperative care for patients who undergo EVT for LVO is an evolving field. Anatomic location of LVO may effect odds of recanalization. We report significant increases of total recanalization in ICA terminus occlusions as compared to those at the distal M1. Further studies are needed to clarify this relationship.