Scopus
🔓 Açık Erişim
Primary vs. Rescue Medium Vessel Occlusions: Comparative Clinical Outcomes in Patients with Acute Ischemic Stroke
Journal of Clinical Medicine · Kasım 2025
Makale Bilgileri
DergiJournal of Clinical Medicine
Yayın TarihiKasım 2025
Cilt / Sayfa14
Scopus ID2-s2.0-105023064009
Erişim🔓 Açık Erişim
Özet
Background: Medium vessel occlusions (MeVOs) are an increasingly recognized but heterogeneous target for endovascular therapy (EVT). This study aims to compare primary MeVO, rescue MeVO, and large vessel occlusion (LVO) thrombectomy cases to identify which MeVO subtypes derive a meaningful benefit from EVT under appropriate safety conditions. Methods: We retrospectively analyzed a multicenter registry of patients undergoing EVT for acute ischemic stroke. MeVO was defined as the occlusion of the A1-A3, M2-M3, P1-P3, fetal PCA, or PICA segments and classified as primary or rescue. Clinical outcomes were assessed by NIHSS score at baseline, discharge, and 90 days; functional outcome by the modified Rankin scale (mRS); and reperfusion by modified thrombolysis in cerebral infarction (mTICI). Safety endpoints included intracranial hemorrhage and mortality. Results: Among 603 EVT patients, 202 (33.5%) had MeVO. Compared to LVO, MeVO patients were older and had more prior strokes but achieved similar reperfusion and safety outcomes. At 90 days, mRS distribution differed, with MeVO showing more mRS 2 and LVO more mRS 1, while higher-disability strata were comparable. Within MeVO, 119 (58.9%) were primary and 83 (41.1%) rescue occlusions. Rescue MeVO patients presented with higher baseline severity (NIHSS score of 19 vs. 18) and, despite similar reperfusion, experienced worse 90-day outcomes and higher mortality (21.7% vs. 0.8%). Conclusions: EVT for primary MeVO is feasible, effective, and safe, whereas rescue MeVO is associated with poor functional outcomes and markedly higher mortality. These findings highlight rescue MeVO as a distinct phenotype and support a selective approach prioritizing disabling syndromes, proximal/dominant branch occlusions, and IVT non-response.
Yazarlar (10)
1
Gokhan Ozdemir
ORCID: 0000-0001-8140-6333
2
Alper Eren
3
Nazım Kizildag
4
Omer Lutfi Gundogdu
ORCID: 0000-0003-4446-8783
5
Ayse Nur Ersoy
6
M. K. Korez
ORCID: 0000-0001-9524-6115
7
Leyla Ozturk-Sonmez
8
Gözde Öngün
ORCID: 0000-0002-3202-2410
9
Nursen Unal
10
Uygar Utku
Anahtar Kelimeler
endovascular therapy (EVT)
ischemic stroke
mechanical thrombectomy
medium vessel occlusion (MeVO)
primary MeVO
rescue thrombectomy
Kurumlar
Atatürk Üniversitesi
Erzurum Turkey
İstinye Üniversitesi
Istanbul Turkey
Kahramanmaras Stroke Centre
Kahramanmaras Turkey
Recep Tayyip Erdoian University
Rize Turkey
Selçuk Üniversitesi
Selçuklu Turkey
University of Health Sciences
Istanbul Turkey