The Source for Neurovascular News and Education

March 29, 2024

 


In a study of stroke patients with acute isolated M1-middle cerebral artery occlusion, response to stent retrievers or aspiration was linked to specific angiographic phenotype.

 

The presence of regular or irregular morphological features could potentially drive the choice of endovascular therapy in patients with M1-middle cerebral artery occlusions, new data suggest. While contact aspiration was found to be more efficacious in patients with a regular angiographic phenotype, stent retrievers were best in those with an irregular phenotype.

“The concept of an association between a specific phenotype of occlusion and a better response to a specific technique may allow the operators to choose the technique that may provide higher recanalization grade and to obtain them faster and with a lower number of maneuvers,” Arturo Consoli, MD (University of Versailles and Saint-Quentin en Yvelines, Suresnes, France), told Neurovascular Exchange.

In a study published online April 4, 2018 ahead of print in Stroke, Consoli and colleagues looked at the angiographic phenotypes of M1-middle cerebral artery occlusions in 84 consecutive patients treated at two experienced comprehensive stroke centers in Europe over a three-month period in 2016. About half (41.7%) of patients were treated with stent retrievers and half with contact aspiration (58.3%).

Occlusions were classified as regular (40%) when the profile of the occlusion was smooth and straight with a linear interruption of the flow in the artery to appeared abruptly cut off; irregular occlusions had evident modification of the linearity of the occlusion such as concave or convex shapes.

Potential for Tailoring Therapy to the Clot

Among patients with regular phenotype, successful recanalization with Thrombolysis in Cerebral Infarction (TICI) of 2b-3 was achieved in 100% of patients treated with contact aspiration compared with only 33.3% of patients treated with stent retrievers (P = 0.001). Additionally, contact aspiration required a median of 1.3 maneuvers vs 2.7 for stent retrievers (P = 0.008).

For irregular phenotypes, TICI 2b-3 was achieved in 73.9% of those treated with stent retrievers compared with 38.5% of patients treated with contact aspiration (P = 0.036). The median number of maneuvers required for stent retrievers in this group was 1.9 vs 3.3 for contact aspiration (P = 0.004).

According to Consoli, the introduction of mechanical thrombectomy has completely modified the outcome for patients with large vessel occlusions, with stent retrievers and contact aspiration both being effective approaches.

“However, in some cases we may achieve late recanalization or it is necessary to perform numerous maneuvers,” Consoli added.

Looking at features of clots on imaging has the potential to change how recanalization is performed, but there are still insufficient data, and the results of this study, though compelling, need to be confirmed in larger populations, Consoli said.

“If confirmed, we would have acquired a new tool to improve and tailor our technique and strategy to the specific case,” he said.

 


 

Sources:

Consoli A, Rosi, A, Coskun O, et al. Thrombectomy for M1-middle cerebral artery occlusion. Angiographic aspect of the arterial occlusion and recanalization: a preliminary observation. Stroke. 2018;Epub ahead of print.

 

Disclosures:

Consoli reports no relevant conflicts of interest.