Mechanical Thrombectomy for Middle Cerebral Artery Medium Vessel Occlusions Using Single Plane Angiography

Overview

Journal Clin Neuroradiol

Specialties Neurology
Radiology

Date 2025 Feb 18

PMID 39966167

Authors

Krishna Amuluru

Jimmy Nguyen

Andrew DeNardo

John Scott

Daniel Gibson

Fawaz Al-Mufti

Dileep Yavagal

Daniel H Sahlein

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Endovascular thrombectomy is now the standard of care for large vessel occlusion acute ischemic stroke. However, acute stroke due to medium-vessel occlusions often result in unfavorable outcomes, and guidelines for thrombectomy are lacking. Moreover, nearly all clinical data and thrombectomy trials are based on biplane angiography systems. This study aims to compare the safety and efficacy of stroke thrombectomy procedures performed on single-plane versus biplane angiography systems in patients presenting with medium-vessel occlusions of the middle cerebral artery.

Materials And Methods: This retrospective study included consecutive patients with acute ischemic stroke due to primary middle cerebral artery medium-vessel occlusions treated with thrombectomy between 7/1/2020 and 8/1/2022 at a single high-volume practice. Patients were dichotomized into those treated on single plane and biplane systems. Demographic, procedural, clinical and follow-up characteristics were compared.

Results: Among the 149 patients included, 44 underwent thrombectomy on single-plane systems, and 93 on biplane systems. No significant differences were detected in rates of good functional outcomes (mRS < 2; SP 54% vs BP 42%, p = 0.19), successful recanalization (TICI ≥ 2B; SP 91% vs BP 86%, p = 0.77), intra-procedural vascular injury (SP 0% vs BP 3%; p = 0.56), or time from groin puncture to reperfusion (SP 25 min vs BP 27 min; p = 0.97). No significant differences were detected in peri-procedural complications, or symptomatic intracerebral hemorrhage.

Conclusion: Thrombectomy for middle cerebral artery medium-vessel occlusions performed on single-plane angiography systems is as safe and efficacious as biplane procedures. Our results may have implications for increasing access to care, especially in regions with limited resources.

References

Goyal M, Menon B, van Zwam W, Dippel D, Mitchell P, Demchuk A . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387(10029):1723-31. DOI: 10.1016/S0140-6736(16)00163-X. View

Nogueira R, Jadhav A, Haussen D, Bonafe A, Budzik R, Bhuva P . Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2017; 378(1):11-21. DOI: 10.1056/NEJMoa1706442. View

Ospel J, Menon B, Demchuk A, Almekhlafi M, Kashani N, Mayank A . Clinical Course of Acute Ischemic Stroke Due to Medium Vessel Occlusion With and Without Intravenous Alteplase Treatment. Stroke. 2020; 51(11):3232-3240. DOI: 10.1161/STROKEAHA.120.030227. View

Saber H, Narayanan S, Palla M, Saver J, Nogueira R, Yoo A . Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a meta-analysis. J Neurointerv Surg. 2017; 10(7):620-624. DOI: 10.1136/neurintsurg-2017-013515. View

Inoue H, Oomura M, Nishikawa Y, Mase M, Matsukawa N . The Feasibility of Mechanical Thrombectomy on Single-Plane Angiosuite: An In-Depth Analysis of Procedure Time. Cerebrovasc Dis Extra. 2021; 11(3):112-117. PMC: 8613560. DOI: 10.1159/000519555. View

Amuluru K, Nguyen J, Al-Mufti F, DeNardo A, Scott J, Yavagal D . Safety and Effectiveness of Mechanical Thrombectomy for Acute Ischemic Stroke Using Single Plane Angiography. J Stroke Cerebrovasc Dis. 2022; 31(8):106553. DOI: 10.1016/j.jstrokecerebrovasdis.2022.106553. View

Guenego A, Mosimann P, Wintermark M, Heit J, Zuber K, Dobrocky T . Safety and Effectiveness of Neuro-thrombectomy on Single compared to Biplane Angiography Systems. Sci Rep. 2020; 10(1):4470. PMC: 7066129. DOI: 10.1038/s41598-020-60851-4. View

Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K . Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American.... Stroke. 2019; 50(12):e344-e418. DOI: 10.1161/STR.0000000000000211. View

Smith W, Lev M, English J, Camargo E, Chou M, Johnston S . Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA. Stroke. 2009; 40(12):3834-40. PMC: 2796543. DOI: 10.1161/STROKEAHA.109.561787. View

10.

Berkhemer O, Fransen P, Beumer D, van den Berg L, Lingsma H, Yoo A . A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2014; 372(1):11-20. DOI: 10.1056/NEJMoa1411587. View

11.

Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M . European Stroke Organisation (ESO)- European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg. 2019; 11(6):535-538. DOI: 10.1136/neurintsurg-2018-014568. View

12.

Grieb D, Schlunz-Hendann M, Brinjikji W, Melber K, Greling B, Lanfermann H . Mechanical thrombectomy of M2 occlusions with distal access catheters using ADAPT. J Neuroradiol. 2019; 46(4):231-237. DOI: 10.1016/j.neurad.2019.01.096. View

13.

Menon B, Hill M, Davalos A, Roos Y, Campbell B, Dippel D . Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions: meta-analysis of data from the HERMES Collaboration. J Neurointerv Surg. 2019; 11(11):1065-1069. DOI: 10.1136/neurintsurg-2018-014678. View

14.

Dargazanli C, Fahed R, Blanc R, Gory B, Labreuche J, Duhamel A . Modified Thrombolysis in Cerebral Infarction 2C/Thrombolysis in Cerebral Infarction 3 Reperfusion Should Be the Aim of Mechanical Thrombectomy: Insights From the ASTER Trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Stroke. 2018; 49(5):1189-1196. DOI: 10.1161/STROKEAHA.118.020700. View

15.

Phan K, Maingard J, Kok H, Dmytriw A, Goyal S, Chandra R . Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis. Neurointervention. 2018; 13(2):100-109. PMC: 6132031. DOI: 10.5469/neuroint.2018.00997. View

16.

Kim C, Kim S, Jeon J . Meta-Analysis of Endovascular Treatment for Acute M2 Occlusion. J Korean Neurosurg Soc. 2019; 62(2):193-200. PMC: 6411567. DOI: 10.3340/jkns.2017.0299. View

17.

Menon B, Al-Ajlan F, Najm M, Puig J, Castellanos M, Dowlatshahi D . Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke. JAMA. 2018; 320(10):1017-1026. PMC: 6143104. DOI: 10.1001/jama.2018.12498. View

18.

Mueller-Kronast N, Zaidat O, Froehler M, Jahan R, Aziz-Sultan M, Klucznik R . Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke: Primary Results of the STRATIS Registry. Stroke. 2017; 48(10):2760-2768. DOI: 10.1161/STROKEAHA.117.016456. View

19.

Saver J, Chapot R, Agid R, Hassan A, Jadhav A, Liebeskind D . Thrombectomy for Distal, Medium Vessel Occlusions: A Consensus Statement on Present Knowledge and Promising Directions. Stroke. 2020; 51(9):2872-2884. DOI: 10.1161/STROKEAHA.120.028956. View

20.

Schulze-Zachau V, Brehm A, Ntoulias N, Krug N, Tsogkas I, Blackham K . Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion thrombectomy. J Neurointerv Surg. 2023; 16(8):775-780. DOI: 10.1136/jnis-2023-020531. View