Thrombectomy appears comparable to medical management in treating ACA occlusion stroke

MECHANICAL THROMBECTOMY appears to be a safe and technically feasible treatment option for ischaemic strokes caused by primary isolated anterior cerebral artery (ACA) occlusions in more distal locations. The procedure—which is more traditionally used in large vessel occlusions (LVOs) of the middle cerebral artery (MCA) and internal carotid artery (ICA)—has also demonstrated similar clinical outcomes to best medical management with or without intravenous thrombolysis (IVT).

These are the key findings of an international registry study published recently in the journal Radiology by Lukas Meyer (University Medical Center Hamburg-Eppendorf, Hamburg, Germany) et al.

As Meyer and his co-authors point out in their introduction, despite thrombectomy being a potential therapeutic option in distal occlusion stroke, current evidence supporting its benefits specifically for primary, isolated distal medium vessel occlusions (MeVOs) in the ACA is, to their knowledge, “generally unknown”. They aimed to elucidate this issue through a case-control study of the TOPMOST registry—an international, retrospective, multicentre, observational registry of patients treated for distal cerebral artery occlusion stroke. Meyer et al analysed the clinical and safety outcomes of thrombectomy for primary, isolated ACA occlusions of the more distal A2–A4 segments, compared to best medical management with or without IVT, in daily clinical practice between January 2013 and October 2021.

In this study, endovascular reperfusion was evaluated using the modified thrombolysis in cerebral infarction (mTICI) scale. The number of reperfusion manoeuvres was counted— including first-pass effect (mTICI 3 after first attempt)—and a final reperfusion result of mTICI 2b–3 was considered a successful thrombectomy, with intervention times and the rate of intervention-related serious adverse events also being detailed.

Regarding clinical measures, early outcome was assessed via the median improvement of National Institutes of Health Stroke Scale (NIHSS) scores at