{
  "abstract": "Background Mechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines the impact of periprocedural embolization to a new vascular territory (ENT) on clinical outcomes in patients with MeVO stroke treated with MT.Methods A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke w­ho underwent MT between September 2017 and July 2023. ENT was defined as filling defects in previously unaffected territories, excluding embolization near the original occlusion, observed on final angiographic runs after retrieval of the primary thrombus. The associations between ENT, procedural variables, and 90-day clinical outcomes were evaluated, including functional independence (modified Rankin Scale (mRS) scores of 0–2), excellent outcomes (mRS 0–1), mortality, and hemorrhagic complications.Results ENT occurred in 2.9% (63/2122) of patients. Longer onset-to-arterial puncture time (adjusted OR 1.03; 95% CI 1.01 to 1.05; P=0.002) and a greater number of passes (adjusted OR 1.15; 95% CI 1.01 to 1.32; P=0.032) were associated with increased ENT risk, while excellent recanalization (thrombolysis in cerebral infarction (TICI) scale score 2c–3) was associated with reduced ENT risk (adjusted OR 0.41; 95% CI 0.23 to 0.72; P=0.002). ENT was not associated with poorer functional independence, mortality, or hemorrhagic complications.Conclusions ENT during MT for MeVO stroke occurs infrequently and does not significantly affect the clinical outcomes. These findings suggest ENT risk should not deter clinicians from performing MT in patients with MeVO. Further prospective studies are needed to validate these results.",
  "authors": [
    {
      "affiliations": [
        "Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA",
        "Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, Texas, USA"
      ],
      "name": "Hamza Adel Salim"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Vivek Yedavalli"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Dhairya A Lakhani"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Fathi Milhem"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Basel Musmar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, Louisiana, USA"
      ],
      "name": "Nimer Adeeb"
    },
    {
      "affiliations": [
        "Department of Radiology, Neuroendovascular Program, University Medical Center Münste, Germany"
      ],
      "name": "Tobias D Faizy"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Motaz Daraghma"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Kareem El Naamani"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA"
      ],
      "name": "Nils Henninger"
    },
    {
      "affiliations": [
        "Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, New Jersey, USA"
      ],
      "name": "Sri Hari Sundararajan"
    },
    {
      "affiliations": [
        "Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA"
      ],
      "name": "Anna Luisa Kuhn"
    },
    {
      "affiliations": [
        "Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, New Jersey, USA"
      ],
      "name": "Jane Khalife"
    },
    {
      "affiliations": [
        "Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, New York, USA"
      ],
      "name": "Sherief Ghozy"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Henri Mondor Hospital, Creteil, France"
      ],
      "name": "Luca Scarcia"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, Texas, USA"
      ],
      "name": "Inayat Grewal"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Leonard LL Yeo"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Division of Neurology, Department of Medicine, National University Hospital, Singapore"
      ],
      "name": "Benjamin YQ Tan"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Robert W Regenhardt"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA"
      ],
      "name": "Jeremy Josef Heit"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Nicole M Cancelliere"
    },
    {
      "affiliations": [
        "University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, Limoges, France"
      ],
      "name": "Aymeric Rouchaud"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal"
      ],
      "name": "Jens Fiehler"
    },
    {
      "affiliations": [
        "Department of Neurology, UTHealth McGovern Medical School, Houston, Texas, USA"
      ],
      "name": "Sunil A Sheth"
    },
    {
      "affiliations": [
        "Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA"
      ],
      "name": "Ajit S Puri"
    },
    {
      "affiliations": [
        "Neuroradiology Department, Sana Kliniken, Lübeck, Germany"
      ],
      "name": "Christian Dyzmann"
    },
    {
      "affiliations": [
        "Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA"
      ],
      "name": "Marco Colasurdo"
    },
    {
      "affiliations": [
        "Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy"
      ],
      "name": "Leonardo Renieri"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "João Pedro Filipe"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA"
      ],
      "name": "Pablo Harker"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France"
      ],
      "name": "Răzvan Alexandru Radu"
    },
    {
      "affiliations": [
        "Departments of Radiology & Neurology, Boston Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Mohamad Abdalkader"
    },
    {
      "affiliations": [
        "Departments of Radiology & Neurology, Boston Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Piers Klein"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Thomas R Marotta"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Julian Spears"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan"
      ],
      "name": "Takahiro Ota"
    },
    {
      "affiliations": [
        "Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, California, USA"
      ],
      "name": "Ashkan Mowla"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Pascal Jabbour"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA"
      ],
      "name": "Arundhati Biswas"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France"
      ],
      "name": "Frédéric Clarençon"
    },
    {
      "affiliations": [
        "Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, New Jersey, USA"
      ],
      "name": "James E Siegler"
    },
    {
      "affiliations": [
        "Departments of Radiology & Neurology, Boston Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Thanh N Nguyen"
    },
    {
      "affiliations": [
        "Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal"
      ],
      "name": "Ricardo Varela"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA"
      ],
      "name": "Amanda Baker"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA"
      ],
      "name": "Muhammed Amir Essibayi"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA"
      ],
      "name": "David Altschul"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA"
      ],
      "name": "Nestor Gonzalez"
    },
    {
      "affiliations": [
        "Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany"
      ],
      "name": "Markus A Möhlenbruch"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France"
      ],
      "name": "Vincent Costalat"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France",
        "INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France"
      ],
      "name": "Benjamin Gory"
    },
    {
      "affiliations": [
        "Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany"
      ],
      "name": "Christian Paul Stracke"
    },
    {
      "affiliations": [
        "Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria"
      ],
      "name": "Constantin Hecker"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France"
      ],
      "name": "Gaultier Marnat"
    },
    {
      "affiliations": [
        "Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, New Jersey, USA"
      ],
      "name": "Hamza Shaikh"
    },
    {
      "affiliations": [
        "Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria"
      ],
      "name": "Christoph J Griessenauer"
    },
    {
      "affiliations": [
        "UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA"
      ],
      "name": "David S Liebeskind"
    },
    {
      "affiliations": [
        "UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy"
      ],
      "name": "Alessandro Pedicelli"
    },
    {
      "affiliations": [
        "UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy"
      ],
      "name": "Andrea Maria Alexandre"
    },
    {
      "affiliations": [
        "Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium"
      ],
      "name": "Illario Tancredi"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Henri Mondor Hospital, Creteil, France"
      ],
      "name": "Erwah Kalsoum"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium"
      ],
      "name": "Boris Lubicz"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Aman B Patel"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Vitor Mendes Pereira"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, Texas, USA"
      ],
      "name": "Max Wintermark"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium"
      ],
      "name": "Adrien Guenego"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA",
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [],
      "name": "for the MAD MT Investigators"
    }
  ],
  "title": "Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study",
  "uid": "560e88a8-e3bb-5d17-bde7-afcfdefb4dae"
}