Concurrent Anterior Cerebral Artery and Middle Cerebral Artery Occlusions Predict Poor Neurological Outcome Despite Successful Thrombectomy in Anterior Circulation Stroke.

Authors

Alice Hsu, Bachar El Baba, Sheila Eshraghi, Francesca Giraudo, Sepehr Saberian, Reda Chalhoub, Ali Alawieh, Zvipo Chisango, Brian M Howard, Alejandro M Spiotta, Mohammad-Mahdi Sowlat, Frank Tong, Feras Akbik, Aqueel Pabaney, Pascal Jabbour, Stavropoula I Tjoumakaris, Ilko L Maier, Stacey Q Wolfe, Ansaar Rai, Robert M Starke, Benjamin Gory, Marios-Nikos Psychogios, Amir Shaban, Nitin Goyal, Joon-Tae Kim, Shinichi Yoshimura, Peter Kan, Reade De Leacy, Isabel Fragata, Adam Polifka, Joshua W Osbun, Richard Williamson, Roberto Javier Crosa, Michael R Levitt, Mark Moss, Min S Park, Walter Casagrande, Charles Matouk, Shakeel A Chowdhry, C Michael Cawley, Jonathan A Grossberg, , On behalf of the STAR Collaborators

Published in

Neurosurgery. Jul 31, 2025. Epub Jul 31, 2025.

Abstract

Despite successful endovascular thrombectomy for acute ischemic stroke, a significant proportion of patients demonstrate fast and early progression of infarct core and fail to achieve functional independence at 90 days. The aim of this study was to evaluate the impact of thrombus location and the potential impact of collaterals on concurrent middle cerebral artery (MCA) and anterior cerebral artery (ACA) occlusion.
Data were included from a multicenter registry for patients undergoing endovascular thrombectomy for anterior circulation stroke from 32 international centers between 2015 and 2021. Patients were included based on thrombus location and categorized into intracranial internal carotid artery (ICA), ICA + MCA, ICA + ACA, or MCA + ACA cohorts. The primary outcome was 90-day functional independence, defined as a modified Rankin Score (mRS) of 0-2. Secondary outcomes included successful recanalization, procedure time, and rates of postprocedural hemorrhage.
In total, 2067 patients were included in the study with 83 patients (4%) having concurrent MCA + ACA occlusions. There were no differences in age, comorbidities, or intravenous thrombolysis use between the ICA and MCA + ACA groups. On univariate analysis, the MCA + ACA group had a significantly lower proportion of patients achieving mRS 0-2 at 90 days (12% vs 33%, P < .05) compared with the ICA groups. There were no differences in secondary technical outcomes between the 2 groups (P > .05); however, mortality was higher in the MCA + ACA group (22 vs 13%) (P < .05). On multivariate regression, MCA + ACA location was an independent predictor of lower odds of mRS 0-2 compared with the ICA group overall (adjusted odds ratio = 0.52, P = .048) and in patients with successful recanalization (adjusted odds ratio = 0.45, P = .035).
Despite similar vascular territories, concurrent occlusion of the MCA and ACA segments results in worse clinical outcomes compared with intracranial ICA occlusion.

PMID:
40742212
Bibliographic data and abstract were imported from PubMed on 31 Jul 2025.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.