Abstract Details

Title Endovascular Thrombectomy for Acute Ischemic Stroke due to Distal Medium Vessel Occlusion: A Systematic Review and Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S10 - Vascular Interventions and Innovative Technologies (11:39 AM-11:51 AM)

Poster/Presentation
Number 003

Background EVT is well recognized as an effective treatment for proximal large vessel occlusions (LVOs) but its use for DMVOs remains a topic of scientific discussion. EVTs in distal medium vessel occlusions were considered high-risk due to reduced vessel size and tortuosity, but newer techniques and recent efforts to explore the EVT potential have encouraged us to revisit thrombectomy indications.

Objective Studies exploring the efficacy of endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) caused by distal medium vessel occlusions (DMVOs) have shown conflicting results. We thus performed a systematic review and meta-analysis to compare its efficacy and safety with the best medical therapy (BMT) in treating primary DMVOs.

Design/Methods

A comprehensive search was performed on Pubmed and Google Scholar from inception to October 2023. Efficacy outcomes of interest included functional independence (90-day modified Rankin scale (mRS) 0–2) and excellent functional outcomes (90-day mRS 0–1). Safety outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Statistical analysis was performed on Review Manager (RevMan) version 5.3.

Results Seventeen observational studies and two randomized controlled trials were included in this meta-analysis with a total sample size of 2973; 1525 patients receiving EVT and 1448 patients receiving BMT. Our preliminary analysis showed that there is no significant difference between EVT and BMT in terms of functional independence (OR 0.97 , 95% CI 0.81-1.16 , p value 0.75), excellent functional outcomes (OR 1.19 , 95% CI 0.96-1.48 , p value 0.11), sICH ( OR 1.55 , 95% CI 0.71-3.36 , p value 0.27) and mortality ( OR 0.94 , 95% CI 0.73-1.23 p value 0.67).

Conclusions BMT is comparable to EVT in ischemic stroke due to distal medium vessel occlusions (AIS-DMVOs). However, the limited number of RCTs and lack of subgroup or sensitivity analysis in our preliminary results warrant cautious interpretation.

Authors/Disclosures
Muhammad Aemaz Ur Rehman, MD PRESENTER	Dr. Aemaz Ur Rehman has nothing to disclose.
FNU Javairia	Ms. Javairia has nothing to disclose.
Ramla Ejaz	Ms. Ejaz has nothing to disclose.
Ayesha Imran, MBBS	Dr. Imran has nothing to disclose.
Rabbiya Ali, Student	Miss Ali has nothing to disclose.
Mahnoor Shaikh	Miss Shaikh has nothing to disclose.
Momina Abid, student	Ms. Abid has nothing to disclose.
Amna Malik	No disclosure on file
Warda Fatmi	Dr. Fatmi has nothing to disclose.