Abstract Body: Introduction: Acute ischemic stroke (AIS) arising from Medium vessel occlusions (MeVO) poses substantial challenges in treatment and management. This study aims to elucidate the outcomes and factors contributing to achieving excellent recanalization (mTICI 2c-3) versus successful recanalization (mTICI 2b) in MeVO stroke patients undergoing mechanical thrombectomy (MT).
Methods: We conducted a multinational study analyzing data from the MAD-MT registry, encompassing 37 centers across North America, Asia, and Europe, collected between September 2017 and July 2023. The study included AIS patients with MeVO treated with MT, with or without intravenous thrombolysis (IVT), who achieved mTICI 2b-3 post-MT.
Results: Among 1,463 patients with successful recanalization (mTICI 2b-3), 523 achieved mTICI 2b recanalization, and 940 achieved mTICI 2c-3. Distal occlusions exhibited higher odds of excellent recanalization compared to proximal MeVO vessel occlusions (OR, 1.58; 95% CI, 1.17-2.15; p=0.003). Cardioembolic stroke etiology was associated with a higher likelihood of excellent recanalization (1.67; 95% CI, 1.07-2.59; p=0.018). Patients achieving mTICI 2c-3 recanalization demonstrated lower initial NIHSS scores, significant improvements in post-procedural NIHSS shift, and a higher percentage of favorable 90-day outcomes compared to those with mTICI 2b. However, no significant difference in 90-day mortality rates was observed.
Conclusion: This study underscores that among MeVO stroke patients with successful recanalization (mTICI 2b-3) there is higher likelihood of achieving excellent recanalization (mTICI 2c-3) in distal occlusions and cardioembolic etiology. mTICI 2c-3 scores post-MT correlate with improved clinical outcomes compared to mTICI 2b, affirming the superiority of excellent recanalization over successful recanalization in MeVO stroke patients. Further prospective studies and randomized controlled trials are warranted for validation.