BACKGROUND: There is a paucity of data regarding mechanical thrombectomy (MT) in distal arterial occlusions (DAO). We aim to evaluate the safety and efficacy of MT in patients with DAO and compare their outcomes with proximal arterial occlusion (PAO) strokes. METHODS: The Trevo Registry was a prospective open-label MT registry including 2008 patients from 76 sites across 12 countries. Patients were categorized into: PAO: intracranial ICA, and MCA-M1; and DAO: MCA-M2, MCA-M3, ACA, and PCA. Baseline and outcome variables were compared across the PAO vs DAO patients with pre-morbid mRS 0-2. RESULTS: Among 407 DAOs including 350 (86.0%) M2, 25 (6.1%) M3, 10 (2.5%) ACA, and 22 (5.4%) PCA occlusions, there were 376 DAO with pre-morbid mRS 0-2 which were compared with 1268 PAO patients. The median baseline NIHSS score was lower in DAO (13 [8-18] vs 16 [12-20], P<0.001). There were no differences in terms of age, sex, IV-tPA use, co-morbidities, or time to treatment across DAO vs PAO. The rates of post-procedure reperfusion, symptomatic intracranial hemorrhage (sICH), and 90-mortality were comparable between both groups. DAO showed significantly higher rates of 90-day mRS 0-2 (68.3% vs 56.5%, P<0.001). After adjustment for potential confounders, the level of arterial occlusion was not associated with the chances of excellent outcome (DAO for 90-day mRS 0-1: OR; 1.18, 95% CI [0.90 to 1.54], P=0.225), successful reperfusion or SICH. However, DAO patients were more likely to be functionally independent (mRS 0-2: OR; 1.45, 95% CI [1,09 to 1.92], P=0.01) or dead (OR; 1.54, 95% CI [1.06 to 2.27], P=0.02) at 90 days. CONCLUSION: Endovascular therapy in DAO appears to result in a comparable safety and technical success profile as in PAO. The potential benefits of DAO thrombectomy should be investigated in future randomized trials.

Advocate Neurovascular Center Advocate Health Care Library Network Park Ridge Illinois USA

Department of Interventional Neuroradiology Centre Hospitalier Regional Universitaire de Lille Lille France

Department of Neurology California Pacific Medical Center San Francisco California USA

Department of Neurology Marcus Stroke and Neuroscience Center Grady Memorial Hospital Emory University School of Medicine Atlanta Georgia USA

Department of Neurology UCLA Los Angeles California USA

Department of Neurology Vascular Neurology of Southern California Thousand Oaks California USA

Department of Neuroradiology CHUV Lausanne VD Switzerland

Department of Neuroradiology Riverside Methodist Hospital Columbus Ohio USA

Department of Neuroradiology University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Neurosciences Drexel University College of Medicine Philadelphia Pennsylvania USA

Department of Neurosciences WellStar Health System Atlanta Georgia USA

Department of Radiology Diagnostic and Interventional Neuroradiology Section Regional University Hospital Centre Tours Tours Centre France

Department of Radiology University of Maryland School of Medicine Baltimore Maryland USA

Department of Radiology University of Tennessee Chattanooga TN USA

Division of Biostatistics Stryker Neurovascular Fremont California USA

Neurointerventional and Comprehensive Stroke Program Saint Mary Medical Center Long Beach California USA

Neurology University of Texas McGovern Medical School Houston Texas USA

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