Multivessel Occlusion in Patients Subjected to Thrombectomy: Prevalence, Associated Factors, and Clinical Implications.

Kaesmacher, Johannes; Mosimann, Pascal John; Giarrusso, Mattia; El-Koussy, Marwan; Zibold, Felix; Piechowiak, Eike Immo; Dobrocky, Tomas; Meier, Raphael; Jung, Simon; Bellwald, Sebastian; Arnold, Marcel; Mordasini, Pasquale; Fischer, Urs; Gralla, Jan (2018). Multivessel Occlusion in Patients Subjected to Thrombectomy: Prevalence, Associated Factors, and Clinical Implications. Stroke, 49(6), pp. 1355-1362. Lippincott Williams & Wilkins 10.1161/STROKEAHA.118.021276

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BACKGROUND AND PURPOSE

Patients with embolic large-vessel occlusion may present with additional coincidental acute occlusions within or distant from the involved territory, referred to as multivessel occlusion (MVO). Purpose of this study was to assess prevalence of MVO, associated factors, and clinical relevance in patients undergoing endovascular stroke treatment.

METHODS

Image data of consecutive endovascular candidates (n=720) with direct access to angiography were extracted from a prospective registry. Prevalence of MVO was assessed with multimodal magnetic resonance imaging/computed tomography and confirmed by intra-arterial angiography. Explorative analysis of associated factors and clinical relevance was evaluated using multivariable logistic regression including variables with <0.15 in univariate comparison. Good functional outcome was defined as modified Rankin scale score ≤2 at day 90.

RESULTS

MVO was present in 10.7% of patients (95% confidence interval [CI], 6.4%-13.0%). Two, 3, and 4 concomitant occlusions were found in 80.5%, 16.9%, and 2.6% of MVO cases, respectively. Detection rate on initial radiological report was 54.5%. Downstream MVO was present in around one third of MVO (n=27/77, 35.1%), whereas all other MVO (n=50/77, 64.9%) occurred in different territories. Independent factors related to MVO were statin treatment (adjusted odds ratio [aOR], 0.477; 95% CI, 0.276-0.827), higher systolic blood pressure (aOR per mm Hg increase, 1.014; 95% CI, 1.005-1.023), and primary occlusion site M2 (aOR, 1.870; 95% CI, 1.103-3.170). MVO was related to lower rates of successful reperfusion (aOR, 0.549; 95% CI, 0.316-0.953) and lower rates of good functional outcome (aOR, 0.437; 95% CI, 0.207-0.923).

CONCLUSIONS

Every tenth patient subjected to angiography for endovascular stroke treatment experienced MVO in our series, and only half were prospectively identified on preinterventional diagnostic imaging. Patients with MVO had higher baseline systolic blood pressure and were less often medicated with statins, an observation that warrants external validation and evaluation regarding causality. Occurrence of MVO has implication for treatment decisions, negatively affects endovascular treatment success, and is predictive of worse clinical outcome.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology 04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
UniBE Contributor:	Kaesmacher, Johannes, Mosimann, Pascal John, El-Koussy, Marwan, Zibold, Felix, Piechowiak, Eike Immo, Dobrocky, Tomas, Meier, Raphael, Jung, Simon, Bellwald, Sebastian, Arnold, Marcel, Mordasini, Pasquale Ranato, Fischer, Urs Martin, Gralla, Jan
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0039-2499
Publisher:	Lippincott Williams & Wilkins
Language:	English
Submitter:	Martin Zbinden
Date Deposited:	29 May 2018 09:14
Last Modified:	02 Mar 2023 23:30
Publisher DOI:	10.1161/STROKEAHA.118.021276
PubMed ID:	29769241
Uncontrolled Keywords:	angiography blood pressure embolism prevalence thrombectomy
URI:	https://boris.unibe.ch/id/eprint/116688