Single-Center Experience Using the STENT RETRIEVER for the Treatment of Acute Ischemic Stroke with Distal Arterial Occlusions (M2, M3, A2, and P2 segments)

Background and Purpose— Endovascular treatment is the standard of care for the treatment of proximal large
arterial occlusion related ischemic strokes. Patients with acute ischemic stroke in the anterior circulation are at risk
for either primary or, following mechanical thrombectomy, secondary occlusion of the distal arteries. The safety and
efficacy of endovascular treatment in the treatment of distal intracranial occlusions has not been well studied.
Methods— From an institutional database we selected consecutive patients treated with stent retriever for distal
arterial occlusions. Recanalization success was measured by applying the Thrombolysis in Cerebral Infarction (TICI)
score. To assess safety, we recorded device-related procedural events and potentially device-related hemorrhages
on follow-up imaging. Infarcts in the dependent territory served as a measure for efficacy. Distal arterial occlusions
were defined as any segment beyond anterior communicating [ACOM] in anterior cerebral artery (ACA), beyond
posterior communicating [PCOM] in posterior cerebral artery, or occlusion at or distal to the middle cerebral artery
(MCA)-M2 segment.
Results— Of 330 patients included in this analysis, we identified 42 (12%) patients with distal arterial occlusions.
The recanalization rate with use of a stent retriever was 81% in these 42 patients. Periprocedural complications
included vasospasms (n = 3, 7.1%) and distal embolization (n = 2, 4.8%). Asymptomatic post-thrombectomy
intracerebral hemorrhages were seen in 9.52% (4/42) of the patients. At 90 days, functional independence (defined
by modified Rankin scale of 0-2) was achieved in 88.7% (36/42) of patients with distal arterial occlusions.
Conclusions— Endovascular treatment using stent retrievers results in high rates of recanalization and functional
independence in ischemic stroke patients with distal arterial occlusions.