{
  "abstract": "Background The ESCAPE-MeVO (Endovascular Treatment to Improve Outcomes for Medium Vessel Occlusions) and DISTAL (Endovascular Therapy plus Best Medical Treatment vs Best Medical Treatment Alone for Medium Vessel Occlusion Stroke) trials failed to demonstrate the superiority of endovascular thrombectomy over best medical management for medium and small vessel occlusions. Potential limitations of these trials include older patient populations, lower presenting National Institutes of Health Stroke Scale (NIHSS) scores, higher rates of premorbid disability, delayed revascularization times, inclusion of both medium and small vessel occlusions, and widespread use of stent retrievers. Here we present M2 occlusion data from the Imperative Trial, evaluating aspiration thrombectomy with the Zoom System.Methods The Imperative Trial is a prospective, multicenter, single-arm trial with independent core lab and safety board adjudication, evaluating aspiration thrombectomy with the Zoom System (Imperative Care, Campbell, CA, USA) for large vessel, including M2, occlusions. This subanalysis includes patients with primary M2 occlusions. Angiographic outcomes were defined as modified Treatment in Cerebral Infarction (mTICI) score ≥2b (good) and ≥2c (excellent). Clinical outcomes were defined as modified Rankin Scale score (mRS) 0–2 (good) and 0–1 (excellent) at 90 days. Safety was assessed by all-cause mortality, symptomatic intracranial hemorrhage (sICH), and all hemorrhage.Results Of 260 enrolled patients, 25% (65/260) had primary M2 occlusions. Median age was 69 years; median NIHSS was 13. Good and excellent reperfusion were achieved in 88% (57/65) and 66% (43/65), respectively. At 90 days, good and excellent clinical outcomes occurred in 62% (39/63) and 56% (35/63), respectively. Mortality, sICH, and any hemorrhage were 4.6% (3/65), 1.5% (1/65), and 18% (12/65), respectively.Conclusions The Zoom System demonstrated excellent safety and efficacy in M2 occlusions. These findings support aspiration thrombectomy for M2 occlusions as a viable treatment in well-selected patients.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA"
      ],
      "name": "Justin R Mascitelli"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Reade Andrew De Leacy"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Keck School of Medicine of USC Los Angeles, Los Angeles, California, USA"
      ],
      "name": "William Mack"
    },
    {
      "affiliations": [
        "Department of Neurology and Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Raul Nogueira"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Shahram Majidi"
    },
    {
      "affiliations": [
        "Huntsville Hospital, Huntsville, Alabama, USA"
      ],
      "name": "Robert Dana Tomalty"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of South Florida, Tampa, Florida, USA"
      ],
      "name": "Maxim Mokin"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA"
      ],
      "name": "Jan Vargas"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Brett L Cucchiara"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Kenneth V Snyder"
    },
    {
      "affiliations": [
        "Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA"
      ],
      "name": "Victoria Parada"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA"
      ],
      "name": "Hakeem J Shakir"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Munson Medical Center, Traverse City, Michigan, USA"
      ],
      "name": "David Rosenbaum-Halevi"
    },
    {
      "affiliations": [
        "Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA"
      ],
      "name": "Amin Aghaebrahim"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, The University of Tennessee Health Science Center, Memphis, Tennessee, USA"
      ],
      "name": "Daniel Hoit"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, John Muir Health Medical Center, Walnut Creek, California, USA"
      ],
      "name": "Benjamin Yim"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Southern California, Los Angeles, California, USA"
      ],
      "name": "Matthew S Tenser"
    },
    {
      "affiliations": [
        "Department of Neurology and Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Alhamza R Al-Bayati"
    },
    {
      "affiliations": [
        "Department of Radiology, Ochsner Medical System, New Orleans, Louisiana, USA"
      ],
      "name": "James M Milburn"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Ohio State University, Columbus, Ohio, USA"
      ],
      "name": "Shahid M Nimjee"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Montefiore Medical Center, New York, New York, USA"
      ],
      "name": "Neil Haranhalli"
    },
    {
      "affiliations": [
        "Department of Neurology, UTHealth McGovern Medical School, Houston, Texas, USA"
      ],
      "name": "Michael Nahhas"
    },
    {
      "affiliations": [
        "Department of Neurointerventional Radiology, Lehigh Valley Hospital, Allentown, Pennsylvania, USA"
      ],
      "name": "Darryn Shaff"
    },
    {
      "affiliations": [
        "Department of Neurointerventional Radiology, Baylor University Medical Center, Dallas, Texas, USA"
      ],
      "name": "Kennith F Layton"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Tallahassee Memorial Hospital, Florida State University, Tallahassee, Florida, USA"
      ],
      "name": "Narlin Beaty"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Miami Health System, Miami, Florida, USA"
      ],
      "name": "Robert M Starke"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Erlanger Health System, Chattanooga, Tennessee, USA"
      ],
      "name": "Harris Hawk"
    },
    {
      "affiliations": [
        "Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Diogo C Haussen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Aqueel Pabaney"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Christopher Paul Kellner"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Jonathan A Grossberg"
    }
  ],
  "title": "Clinical outcomes and independently adjudicated results of M2 aspiration thrombectomy: a subgroup analysis from the Imperative Trial",
  "uid": "f7ca98d9-0947-52c1-a77f-f1792a0d84e2"
}