Abstract
The reproducible data from the major mechanical thrombectomy (MT) trials has demonstrated significant benefit of patients undergoing endovascular MT for large vessel occlusion in the internal carotid artery, M1 segment of the middle cerebral artery (MCA), vertebral artery, and basilar artery. Subsequent studies have demonstrated similar clinical benefits of revascularization of occluded M2 segments of the MCA. There are only a few relatively small series that examine mechanical thrombectomy, either aspiration alone or in conjunction with a stent retriever for more distal arteries. This chapter reviews the limited data on MT for revascularization of the anterior cerebral artery, the M3 and M4 MCA segments, and the posterior cerebral arteries. It reviews techniques in dealing with revascularization of these intermediate-sized arteries. Case examples are presented of each of the major distal occlusion vascular territories.
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References
Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, The MR CLEAN Investigators, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30.
Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, The REVASCAT Trial Investigators, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.
Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372:2285–95.
Campbell BC, Mitchell PI, Kleinig TI, Dewey HM, Churilov I, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion imaging selection. N Engl J Med. 2015;372:1009–18.
Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, The DEFUSE 3 Investigators, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18.
Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, The DAWN Investigators, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21.
Flores A, Tomasello A, Cardona P, Angeles de Miquel M, Gomis M, Garcia Bermejo P, Catalan Stroke Code and Reperfusion Consortium (Cat-SCR), et al. Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience. J Neurointerv Surg. 2015;7:234–7.
Dorn F, Lockau H, Stetefeld H, Kabbasch C, Kraus B, Dohmen C, et al. Mechanical thrombectomy of M2-occlusion. J Stroke Cerebrovasc Dis. 2015;24:1465–70.
Park JS, Kwak HS. Manual aspiration thrombectomy using penumbra catheter in patients with acute M2 occlusion: a single-center analysis. J Korean Neurosurg Soc. 2016;59:352–6.
Countinho JM, Liebeskind DS, Slater LA, Nogueira RG, Baxter BW, Levy EI, et al. Mechanical thrombectomy for isolated M2 occlusions: a post hoc analysis of the STAR, SWIFT, and SWIFT PRIME studies. AJNR Am J Neuroradiol. 2016;37:667–72.
Kim YW, Son S, Kang DH, Hwang YH, Kim YS. Endovascular thrombectomy for M2 occlusions: comparison between forced arterial suction thrombectomy and stent retriever thrombectomy. J Neurointerv Surg. 2017;9:626–30.
Sarraj A, Sangha N, Hussain MS, Wisco D, Vora N, Elijovich L, et al. Endovascular therapy for acute ischemic stroke with occlusion of the middle cerebral artery M2 segment. JAMA Neurol. 2017;74:488–9.
Saber H, Narayanan S, Palla M, Saver JL, Nogueira RG, Yoo AJ, et al. Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a meta-analysis. J Neurointerv Surg. 2018;10:620–4.
Salahuddin H, Ramaiah G, Slawski DE, Shawver J, Buehler M, Zaidi SF, et al. Mechanical thrombectomy of M1 and M2 middle cerebral artery occlusions. J Neurointerv Surg. 2018;10:330–4.
Grossberg JA, Rebello LC, Haussen DC, Bouslama M, Bowen M, Barreira CM, et al. Beyond large vessel occlusion strokes: distal occlusion thrombectomy. Stroke. 2018;49:1662–8.
Vargas J, Spiotta AM, Fargen K, Turner RD, Chaudry I, Turk A. Experience with a direct aspiration first pass technique (ADAPT) for thrombectomy in distal cerebral artery occlusions causing acute ischemic stroke. World Neurosurg. 2017;99:31–6.
Meyne JK, Zimmermann PR, Rohr A, Riedel C, Hansen HC, Pulkowski U, et al. Thrombectomy vs. systemic thrombolysis in acute embolic stroke with high clot burden: a retrospective analysis. Rofo. 2015;187:555–60.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 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 Association. Stroke. 2019;50:e344–418.
Anadani M, Alawieh A, Arthur AS, Kim JT, De Leacy R, Maier I, The STAR Collaborators, et al. Mechanical thrombectomy for distal occlusions: efficacy, functional and safety outcomes: insight from the STAR collaboration. Presented at the International Stroke Conference, Los Angeles, CA, February 2020.
Turk AS, Spiotta A, Frei D, Mocco J, Baxter B, Fiorella D, et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg. 2014;6:231–7.
Hui FK, Hussain MS, Spiotta A, Bhalla T, Toth G, Moskowitz SI, et al. Merci retrievers as access adjuncts for reperfusion catheters: the grappling hook technique. Neurosurgery. 2012;70:456–60.
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Do, A.S.M.S., Babadjouni, R.M., Alexander, M.J. (2021). Thrombectomy for Acute Occlusion in Intermediate-Sized Distal Arteries. In: Hui, F.K., Spiotta, A.M., Alexander, M.J., Hanel, R.A., Baxter, B.W. (eds) 12 Strokes. Springer, Cham. https://doi.org/10.1007/978-3-030-56857-3_15
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