Hansen Björn M, Hall Emma, Ramgren Birgitta, Ullberg Teresa, Wassélius Johan
Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.
Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.
Clin Neuroradiol. 2025 Mar 31. doi: 10.1007/s00062-025-01511-w.
Medium vessel occlusions (MeVO) can be either isolated events (primary), or secondary to thrombus migration from a large vessel occlusion to a medium-sized vessel. Outcomes following endovascular thrombectomy (EVT) in the middle cerebral artery (MCA) may differ between primary and secondary MeVOs. This study aimed to assess the association between primary/secondary MeVOs and clinical outcomes following EVT in a nationwide patient cohort.
Patients undergoing EVT were included in two Swedish quality registries. Secondary MeVO was defined as distal migration of a solitary thrombus between baseline CT-angiography and EVT, or basal ganglia infarction on postoperative CT in a patient that presented with a single MeVO on baseline CT-angiography. The primary outcome was good 90-day functional outcome (modified Rankin Scale 0-2). Postoperative change in the National Institutes of Health Stroke Scale-score (NIHSS), was a secondary outcome. Successfully revascularized patients (mTICI 2b-3) were compared with non-revascularized patients in exploratory analyzes.
Of the 5662 EVTs performed in Sweden (2018-2022), 1118 (20%) targeted solitary MCA territory MeVOs, with 819 (73%) being primary and 299 (27%) secondary. Functional outcomes did not differ between the primary and secondary MeVO groups (OR 0.86, CI 95% 0.65-1.14). Likewise, there was no significant difference in postoperative NIHSS scores (0.26, CI 95% -0.71 to 1.24), between groups (p = 0.597). Successful revascularization was associated with increased chance of good functional outcome for both primary (OR 3.77, CI95% 2.28-6.24, p < 0.001) and secondary MeVOs (OR 2.49, CI95% 1.21-5.14, p = 0.013).
Patients with a single primary or secondary MCA MeVOs have similar EVT outcomes and both groups seem to benefit from recanalization in exploratory analyses. This indicates that that EVT should not be withheld based on primary/secondary MeVO status.
中型血管闭塞（MeVO）可以是孤立事件（原发性），也可以是继发于血栓从大血管闭塞向中型血管的迁移。大脑中动脉（MCA）血管内血栓切除术（EVT）后的结果在原发性和继发性MeVO之间可能有所不同。本研究旨在评估在全国范围内的患者队列中，原发性/继发性MeVO与EVT后临床结果之间的关联。
接受EVT的患者被纳入两个瑞典质量登记处。继发性MeVO被定义为在基线CT血管造影和EVT之间单个血栓的远端迁移，或在基线CT血管造影上表现为单个MeVO的患者术后CT上的基底节梗死。主要结局是90天良好功能结局（改良Rankin量表0-2）。美国国立卫生研究院卒中量表评分（NIHSS）的术后变化是次要结局。在探索性分析中，将成功再通的患者（mTICI 2b-3）与未再通的患者进行比较。
在瑞典进行的5662例EVT中（2018-2022年），1118例（20%）针对孤立的MCA区域MeVO，其中819例（73%）为原发性，299例（27%）为继发性。原发性和继发性MeVO组之间的功能结局没有差异（OR 0.86，95%CI 0.65-1.14）。同样，两组之间术后NIHSS评分也没有显著差异（0.26，95%CI -0.71至1.24）（p = 0.597）。成功再通与原发性（OR 3.77，95%CI 2.28-6.24，p < 0.001）和继发性MeVO（OR 2.49，95%CI 1.21-5.14，p = 0.013）获得良好功能结局的机会增加相关。
患有单个原发性或继发性MCA MeVO的患者具有相似的EVT结局，并且在探索性分析中两组似乎都从再通中获益。这表明不应基于原发性/继发性MeVO状态而不进行EVT。
