Mechanical Thrombectomy in Medium Vessel Occlusion: Systematic Review of Efficacy and Outcome Determinants
Lakshmi Sai Deepak Reddy Velugoti1, Lakshmi Vandana Chintalapati2, Shravya Pingili3, Ayaz Khawaja4, Ramesh Madhavan5
1Neurology, Garden City Hospital, 2NRI Medical College, 3Internal Medicine, UCF/HCA Ocala, 4Neurology, Garden city Hospital, 5International Medical Clinic
Objective:
This study aims to systematically review current evidence on the efficacy of mechanical thrombectomy in medium vessel occlusion (MeVO) stroke and to analyze associated factors that influence clinical and angiographic outcomes.
Background:
Mechanical thrombectomy (MT) is the treatment of choice for Large vessel occlusion (LVO) in Cerebrovascular accident; however, previous clinical outcomes were unsatisfactory in medium vessel occlusion (MeVO) due to vessel perforation and less accessibility due to small caliber. Given recent advancements and multiple trials, such as the DISCOUNT, TOPMOST, and ESCAPE MeVo trials, demonstrating its efficacy, we aim to investigate the advanced efficacy of MT in MeVO and its effectiveness in relation to associated factors.
Design/Methods:
We conducted a systematic review following PRISMA guidelines across PubMed and Google Scholar. We included studies if they had effects of mechanical thrombectomy in medium vessel occlusion and associated factors affecting the outcome.
Results:
Through a literature search, we identified 522 studies, and 30 articles met the inclusion criteria. Fifteen articles met the quality assessment score of at least 70%. These fifteen articles included the factors that affected MT in MeVO outcomes. These factors include the use of anticoagulation, aspirin, the possibility of embolization of new territory, device selection, the technique of MT, functional outcomes, recanalization predictors, prognosis, MT vs medical management, and the first-pass effect. These factors had an effect on MT outcomes in these patients. Each factor has its own independent contribution to the outcome.
Conclusions:
when performing MT in MeVo, anticoagulation increases the mortality rate, while aspirin improves the outcome. Low passes and attempts of recanalization have shown better outcomes. Device selection and MT technique have unclear outcomes, as limited data are available. Limitations include small sample size, lack of quantification of the impact of each factor on outcomes, and the absence of long-term outcome data.
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