Abstract 205: Efficacy and Safety of Mechanical Thrombectomy for Primary MeVO with Disabling Deficit

Abstract

Introduction We aimed to evaluate the efficacy and safety of mechanical thrombectomy (MT) for medium vessel occlusion (MeVO) with the disabling deficit. Methods The study period was from January 2011 to December 2022. Inclusion criteria were 1) within 24 hours of stroke onset, 2) prestroke mRS score ≤1, 3) NIHSS score ≥4 or disabling deficit (complete hemianopia (≥2 on NIHSS), severe aphasia (≥2 on NIHSS), visual sensory extinction (≥1 on NIHSS), significant weakness with NIHSS subscore of paralysis ≥2), 4) MeVO (MCA distal M2, M3, ACA A1, A2, A3, PCA P1, P2, and P3). Outcomes were compared between the MT and standard medical treatment (SMT) groups. Outcome was defined as the favorable outcome (mRS score 0‐2 at 90 days), death within 90 days, and symptomatic intracranial hemorrhage (SICH). Results Of all, 192 patients (72 women, median age 78 years, median NIHSS score 11 points) were enrolled, and 76.6% (n=147) had distal M2 occlusion. Compared to the SMT group (n=153), the MT group (n=39) had a significantly larger median Tmax>10 sec volume (median 25 mL vs. 5 mL, P 6‐sec volume (61 mL vs. 44 mL, P<0.01), while median NIHSS score (13 vs. 11, P=0.69) and intravenous thrombus (51.6％ vs. 55.3%, P=0.72) were significantly lower in the MT group. There were significantly more patients in the MT group with a favorable outcome (73.7% vs. 54.1%, adjusted odds ratio 2.59 95% confidence interval 1.07‐6.24), death within 90 days (7.9% vs. 3.1%), SICH (5.3% vs. 4.4%) were not significantly different. In subgroup analysis, MT was independently associated with age (<80 years; 1.33, 1.21‐15.57, P=0.222) and neurological severity (NIHSS ≥10 points; 2.79, 1.07‐7.24, P=0.870) for a favorable outcome. Conclusion In MeVO with disabling deficits, MT was independently associated with more favorable outcomes than the SMT group.