Ammad Mahmood, MBChB, BMedSci
A joint symposium between ESO and ESMINT discussed the challenges faced in acute reperfusion therapies, including patient selection and therapeutic targets.
Endovascular thrombectomy for mid-sized artery occlusions – Raul Nogueira
The importance of IV thrombolysis (IVT) therapy in this patient population was highlighted, and what constitutes mid-sized arteries considered. The anatomical variation of the M2 segment of the MCA makes this definition critical — there is generally agreement on EVT for clots in the proximal portion of larger M2 vessels. The terminology of DMVO — distal medium vessel occlusions — separates proximal dominant M2 occlusions from non-dominant M2 occlusions, as well as M3, ACA, and PCA territories. The literature suggests DMVOs cause 25-40% of acute ischemic stroke either as the primary finding or a secondary embolization complicating mechanical thrombectomy. Although IVT for this population is advocated, only half achieve reperfusion and around 25-33% have functional independence after DMVO stroke, highlighting the room for improvement potentially with EVT. Registry data showed DMVO stroke had moderately high baseline NIHSS with similar rates of reperfusion and complication with EVT compared with more proximal occlusions and up to two-thirds of patients achieving functional independence at 90 days. Patient selection in DMVO stroke needs to take into consideration many factors, including correlation of imaging and clinical findings to determine the eloquence of the area of brain involved, as well as technical considerations of the EVT procedure, such as tortuosity of the vessel, which can making procedures higher risk.