Technical and clinical outcomes in concurrent multivessel occlusions treated with mechanical thrombectomy: insights from the STAR collaboration.

Background: Endovascular thrombectomy (EVT) has become the mainstay treatment for large vessel occlusion, with favorable safety and efficacy profile. However, the safety and efficacy of EVT in concurrent multi-territory occlusions (MTVOs) remains unclear.
Objective: To investigate the prevalence, clinical and technical outcomes of concurrent EVT for MTVOs.
Methods: Data were included from the Stroke Thrombectomy and Aneurysm Registry (STAR) with 32 stroke centers for EVT performed to treat bilateral anterior or concurrent anterior and posterior circulation occlusions between 2017 and 2021. Patients with MTVO were identified, and propensity score matching was used to compare this group with patients with occlusion in a single arterial territory.
Results: Of a total of 7723 patients who underwent EVT for acute ischemic stroke, 54 (0.7%) underwent EVT for MTVOs (mean age 69±12.5; female 50%). 28% had bilateral and 72% had anterior and posterior circulations occlusions. The rate of successful recanalization (Thrombolysis in Cerebral Infarction 2b/3), complications, modified Rankin score at 90 days, and mortality was not significantly different between the matched cohorts. Multivariate analysis confirmed that MTVOs were not associated with poor functional outcome, symptomatic intracranial hemorrhage, or longer procedure time.
Conclusion: Compared with EVT for single vessel occlusions, EVT in appropriately selected patients with MTVOs has a similar efficacy and safety profile.
Competing Interests: Competing interests: SAK: Grant funding-Stryker. PJ: Consultant - Balt, Cerus, Microvention, Medtronic. SQW: Board of directors - AANS; associate editor - S:VIN journal. M-NP: Honoraria - Stryker, Medtronic, Penumbra, Acandis, Phenox, Siemens Healthineers; research support - Swiss National Science Foundation, Bangerter-Rhyner Stiftung, Stryker, Phenox, Medtronic, Rapid, Penumbra, Siemens Healthineers. ASA: Consultant for Arsenal, Balt, Johnson and Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, Stryker; research support from Balt, Medtronic, Microvention, Penumbra, and Siemens; shareholder - Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI. AJP: Consultant - Depuy Synthes, Stryker. JM: consultant - Stryker. CM: Consultant-Silk Road, Penumbra, Microvention, Cerevasc, Stryker; speaker-Silk Road, Penumbra. MSP: DSMB-Medtronic. MRL: Educational grant - Stryker, Medtronic; consultant - Medtronic, Aeaean Advisers; travel Support - Penumbra; editorial board, JNIS; stock - Hyperion Surgical, Proprio, Synchron, Cerebrotech, Fluid Biomed, Stereotaxis; advisor - Metis Innovative. AMS: Consultant - Stryker, Penumbra, Terumo, RapidAI. JAG: Grant support- Georgia Research Alliance, Department of Defense, Emory Medical Care Foundation, Neurosurgery Catalyst; Stock - NTI, Cognition. STAR: funded by Penumbra, Medtronic, Stryker.
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