Mechanical thrombectomy for small and medium vessel occlusion: a Sanford experience

BACKGROUND: Recent clinical trials have established that treatment of acute ischemic stroke secondary to large vessel occlusion with mechanical thrombectomy leads to improved revascularization and functional outcomes. However, there has been little research into expanding the application of mechanical thrombectomy into stroke secondary to small and medium vessel occlusions, which can still produce significant morbidity.
OBJECTIVE: Is to evaluate the outcomes of patients treated with mechanical thrombectomy for acute ischemic stroke secondary to more distal vessel occlusion and to highlight process times from door to intervention in a center that receives patients from rural and underserved areas.
DESIGN AND METHODS: We retrospectively reviewed the electronic medical record of 38 patients admitted to Sanford Health Cerebrovascular Service in Fargo, ND between March 2015 and May 2017 who underwent endovascular intervention for acute ischemic stroke secondary to a small caliber vessel occlusion using devices designed for thrombectomy in small arteries.
RESULTS: At admission, 10 patients had a baseline NIHSS score of more than 10 (26.31%), 14 patients had a baseline NIHSS score of more than 6 (36.84%), the average NIHSS score at admission was 14.61. The average NIHSS score change was — 4.94 after intervention using mechanical thrombectomy. Successful recanalization was achieved in 94.74% of cases. Ninety-day postoperative Modified Rankin Scale (mRS) scores were used as functional outcome measurements and the data were available for 34 patients. The percent of patients achieving mRS of two or less was 56%. Large percentage of patients transferred from outside facilities, the median time from last known normal to arrival in the emergency department was prolonged to 200 minutes. The median time between emergency department arrival and recanalization was 91 minutes.
CONCLUSION: Given the high rates of revascularization, reductions in NIHSS scores, and 90-day mRS scores, mechanical thrombectomy may be reasonably extended to patients with occlusion of smaller, more distal vessels.

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