90-Day Home Times Following Endovascular Thrombectomy for Medium-Vessel Occlusion

Patients with medium-vessel occlusion (MeVO) who receive endovascular thrombectomy (EVT) have similar 90-day home time outcomes compared with patients with large-vessel occlusion (LVO) who receive EVT, according to a study in Stroke: Vascular and Interventional Neurology.

Researchers evaluated predictors of 90-day home time using data from the Quality Improvement and Clinical Research registry in Alberta, Canada, in patients with MeVO vs LVO who received EVT. The data were limited to 1 center that provided EVT to patients in southern Alberta from July 1, 2015, to November 30, 2020.

Patient imaging was reviewed by 2 independent readers who were blinded to clinical data. All participants had baseline computed tomography (CT) and CT angiography, conventional angiography, and follow-up CT or magnetic resonance imaging. The primary outcome was 90-day home time.

Of the 663 patients who had EVT, 139 had MeVO on baseline CT angiography and 524 had LVO. Among the participants, 58.3% had proximal M2 occlusion, 24.5% had distal M2 occlusion, 14.4% had M3/M4 occlusion, and 2.9% had A2–anterior cerebral artery occlusion. Patients with MeVO had a median age of 71 years (50.4% women) compared with patients with LVO (median age, 74 years; 48.3% women).

Successful reperfusion occurred in 86.7% of patients in the MeVO group vs 85.3% in the LVO group (P =.72). In-hospital and 90-day mortality were comparable in the 2 groups.

Data regarding home time were available for all patients. The 90-day home time was increased, but not significantly, in the MeVO group compared with the LVO group in the unadjusted analyses (median, 37 [0-82] vs 32 [0-84]; P =.804). In random forests regression that included MeVO, atrial fibrillation, collateral grade, diabetes, heart failure, hypertension, occlusion site, sex, tandem occlusion, intravenous thrombolysis use, and onset to arterial access time as features and subsequent partial dependence estimates, mean predicted home times were similar in the MeVO (43.5 days) and LVO (43.9 days) groups.

With use of partial dependence estimates, premorbid diabetes (-8.7 days), hypertension (-6.6 days), and atrial fibrillation (-3.4 days) predicted worse 90-day home time. Home time had a constant relationship with age until about age 70 years, when it decreased with increasing age. Home time generally decreased with increasing time from onset to arterial access. No meaningful differences were observed in predicted 90-day home time based on sex, collateral grade, tandem lesion, and thrombolysis use.

Limitations of the study include use of nonrandomized data from a provincial registry, and 90-day home time is not a routine outcome in large clinical trials, which limits direct comparability of the findings. A limitation of home time is that it does not consider the level of assistance required by patients at home or quality of life at home. Also, only patients with primary MeVO who received EVT were included, and the number of patients treated for MeVO in the registry was relatively small.

“Our study demonstrates that patients with disabling strokes due to MeVO who are selected for EVT with similar demographic and clinical profiles to patients with LVO can achieve similar 90-day home time outcomes to patients with LVO,” the study authors wrote.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.