Stent retriever deployment tracing susceptibility vessel sign in the M2 branch predicts the effective first-pass reperfusion in thrombectomy for M1 occlusion.

BACKGROUND AND PURPOSE: Successful first-pass reperfusion is associated with better functional outcomes after mechanical thrombectomy (MT) for acute ischemic stroke, but its treatment strategies remain unclear.

MATERIALS AND METHODS: We retrospectively recruited patients who underwent MT for M1 occlusion between December 2020 and May 2023 at our institution. The locations of susceptibility vessel sign (SVS) on magnetic resonance imaging were classified into M1 only, M1 to single M2 branch, or M1 to both M2 branches. Patients were included in the SVS tracing group when the stent retriever of the first pass covered the entire SVS length. Successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction scale 2b-3. Any intracranial hemorrhage detected at 24-hour postoperatively was included as a hemorrhagic complication.

RESULTS: The SVS was detected in M1 only, M1 to single M2 branch, and M1 to both M2 branches in 8, 22, and 4 patients, respectively. Among the 34 patients, 27 were included in the SVS-tracing group. Successful first-pass reperfusion was significantly more frequent in the SVS-tracing group compared with the non-SVS tracing group (odds ratio (OR), 14.4; 95% confidence interval (95%CI), 2.0-101; P = 0.007). The procedural time was significantly reduced in the SVS tracing group (median, 29 [interquartile range, 22-49] min vs. 63 [43-106] min; P = 0.043). There was a trend towards less frequent hemorrhagic complications in the SVS tracing group (OR, 0.17; 95%CI, 0.029-1.0; P = 0.052).

CONCLUSIONS: This study provides a thrombus imaging-based MT strategy to efficiently achieve first-pass reperfusion in M1 occlusion.