ESOC 2025 | MCA bending length as a predictor of poor outcomes of thrombectomy for distal vessel occlusion
Pere Canals, PhD, of Stanford University, Stanford, CA, discusses a study investigating anatomical characteristics that predict outcomes of thrombectomy for distal vessel occlusion. Dr Canals highlights that the MCA bending length is a strong predictor of poor outcomes, including worse perfusion and increased risk of subarachnoid hemorrhages. This information can be used to identify patients at low risk of adverse events during thrombectomy, potentially leading to improved functional outcomes and paving the way for future trials that demonstrate the benefit of thrombectomy in specific subpopulations. This interview took place at the 11th European Stroke Organisation Conference (ESOC) in Helsinki, Finland.
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Transcript
So after the publication of ESCAPE-MeVo and the DISTAL trials back in February, the disappointing results in these trials were that they failed to show a benefit of thrombectomy or best medical treatment in the population with a distal vessel occlusion. Without these results raised the need for either advancement in device design or better triage methodologies. And one thing that’s different between LVOs and MeVo patients is the anatomy at the intracranial level for the vessels that need to be navigated for performing the thrombectomy...
So after the publication of ESCAPE-MeVo and the DISTAL trials back in February, the disappointing results in these trials were that they failed to show a benefit of thrombectomy or best medical treatment in the population with a distal vessel occlusion. Without these results raised the need for either advancement in device design or better triage methodologies. And one thing that’s different between LVOs and MeVo patients is the anatomy at the intracranial level for the vessels that need to be navigated for performing the thrombectomy. And we hypothesized that the differences in this intracranial vascular anatomy could be an explanation for the worsening in efficacy and safety of thrombectomy over this population. And following our prior work on vascular anatomy characterization through learning methodologies, we developed a semi-automatic pipeline in order to characterize the ICA and the MCA segments of this population. And we used these two segments to derive a series of six different metrics to analyze against results for both efficacy and safety of thrombectomy. What we observed was that on an adjusted logistic regression analysis, the MCA bending length particularly, as well as the tortuosity at the ICA level and the diameter of the occlusion were all associated with worse perfusion outcomes. And regarding safety, we saw that the bending length but not the ICA tortuosity was associated with higher risks of subarachnoid hemorrhages. We think that these anatomical characteristics can be used in the future to select a big chunk of the population receiving thrombectomy in distal vessel occlusions with a very low risk of adverse events during thrombectomy, increasing in turn the functional outcomes of these patients and hopefully making the way for better trials in the future that can demonstrate the benefit of thrombectomy in at least a part of this population.
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