Article Figures & Data
- Figure 1
A MeVO recanalisation by the stent retriever. (A and B) Angiography showed an MCA-M2 branch occlusion (black arrow); (C) microcatheter angiography; (D) a stent retriever with 4–20 mm was deployed across the occlusion branch artery (black arrow); (E and F)recanalisation of the target branch artery after the first thrombectomy attempt. MCA, middle cerebral artery; MeVO, medium vessel occlusion.
- Figure 2
Flow chart of patient selection. EVT, endovascular treatment; LVO, large vessel occlusion; MeVO, medium vessel occlusion; mRS, modified Rankin Scale.
- Table 1
Baseline and procedure characteristics of patients with MeVO and LVO
Baseline and procedure variables All patients (n=1032) MeVO (n=147) LVO (n=885) P value Age, year, median (IQR） 66 (56–74) 67 (59–75) 66 (56–73) 0.120 Men, n (%) 620 (60.1) 75 (51.0) 545 (61.6) 0.016 Hypertension, n (%) 551 (53.4) 81 (55.1) 470 (53.1) 0.654 DM, n (%) 177 (17.2) 23 (15.7) 154 (17.4) 0.601 Hyperlipidaemia, n (%) 80 (7.8) 6 (4.1) 74 (8.4) 0.072 Coronary heart disease, n (%) 149 (14.4) 20 (13.6) 129 (14.6) 0.757 Atrial fibrillation, n (%) 408 (39.5) 59 (40.1) 349 (39.4) 0.872 Valvular heart disease, n(%) 82 (8.0) 6 (4.1) 76 (8.6) 0.061 Prior stroke, n (%) 222 (21.5) 36 (24.5) 186 (21.0) 0.343 Smoking history, n (%) 0.357 Never smoking 665 (64.4) 100 (68.0) 565 (63.8) Previous smoking 65(6.3) 11(7.5) 54(6.1) Current smoking 302(29.3) 36(24.5) 266(30.1) SBP, mm Hg 145 (130–160) 145 (132–160) 144 (130–160) 0.725 Baseline NIHSS* 15 (12–20) 16 (11–19) 15 (12–20) 0.673 ASPECTS† 9 (7–10) 10 (8–10) 9 (7–10) 0.005 Serum glucose, mmol/L, median (IQR) 6.8 (5.9–8.5) 6.7 (5.8–7.9) 6.8 (5.9–8.6) 0.440 Blood WBC, 109/L, median (IQR) 8.2 (6.7–10.2) 8.1 (6.6–10.6) 8.3 (6.8–10.2) 0.816 NLR, median (IQR） 4.2 (2.5–6.9） 4.0 (2.5–7.0) 4.2 (2.5–6.8) 0.788 Pretreatment with antiplatelets, n (%) 163(15.8) 24(16.3) 139(15.7) 0.849 Pretreatment with IVT, n (%) 302 (29.3) 44 (29.9) 258 (29.2) 0.848 Underlying ICAD, n (%) 0.068 Yes 261 (25.3) 26 (17.7) 235 (26.6) No 670 (64.9) 566 (64.0) 104 (70.8) Undetermined 101 (9.8) 17 (11.6) 84 (9.5) General anaesthesia, n (%) 336 (32.6) 44 (29.9) 292 (33.0) 0.463 Stroke subtype by TOAST criteria 0.089 Large artery atherosclerosis 429 (41.6) 55 (37.4) 374 (42.3) Cardioembolism 447 (43.3) 62 (42.2) 385 (43.5) Other or unknown aetiology 108 (10.5) 24 (16.3) 84 (9.5) Undetermined 48 (4.7) 6 (4.1) 42 (4.8) Stent retriever, n (%) 940 (91.1) 133 (90.5) 807 (91.2) 0.780 Aspiration, n (%) 217 (21.0) 15 (10.2) 202 (22.8) 0.001 IAT, n (%) 76 (7.4) 21 (14.3) 55 (6.2) 0.001 Balloon angioplasty, n (%) 143 (13.9) 9 (6.1) 134 (15.1) 0.003 Stenting, n (%) 113 (11.0) 5 (3.4) 108 (12.2) 0.002 GP IIb/IIIa receptor inhibitor during EVT, n (%) 485 (47.0) 53 (36.1) 432 (48.8) 0.004 OTP, min, median (IQR)‡ 300 (212–440) 286 (205–410) 300 (215–450) 0.168 Number of MT passes, median (IQR) 2 (1–3) 1 (1–2) 2 (1–3) 0.001 FPR, n (%) 514 (49.9) 84 (57.5) 430 (48.6) 0.047 Procedure duration, min, median (IQR)§ 80 (50–120) 74 (45–105) 80 (50–125) 0.038 Intraprocedural embolisation, n (%) 59 (5.7) 6 (4.1) 53 (6.0) 0.356 Bold values indicate statistical significance.
*Four missing data.
†Five missing data.
‡ Thirteen missing data.
§ One missing data.
ASPECTS, Alberta Stroke Programme Early CT Score; DM, diabetes mellitus; EVT, endovascular treatment; FPR, first pass recanalisation; IAT, intra-arterial thrombolysis; ICAD, Intracranial atherosclerotic disease; IVT, intravenous thrombolysis; LVO, large vessel occlusion; MeVO, medium vessel occlusion; MT, mechanical thrombectomy; NIHSS, National Institute of Health Stroke Scale; NLR, neutrophil to lymphocyte ratio; OTP, Onset-to-puncture time; SBP, systolic blood pressure; TOAST, Trial of ORG 10172 in Acute Stroke Treatment; WBC, white cell count.
- Table 2
Outcome measures of patients with MeVO/LVO
Outcome variables All patients (n=1032) MeVO (n=147) LVO (n=885) (c)OR (95% CI) P value (c)OR (95% CI) P value Primary outcome 90-day mRS, median (IQR) 3 (0–5) 3 (0–4) 3 (0–5) 1.07 (0.79 to 1.46) 0.657 1.00 (0.73 to 1.38) 0.994 Secondary outcomes 90-day mRS 0–1, n (%) 422 (41.0) 63 (42.9) 359 (40.6) 1.10 (0.77 to 1.56) 0.601 0.98 (0.67 to 1.42) 0.909 90-day mRS 0–2, n (%) 464 (45.0) 66 (44.9) 398 (45.0) 1.00 (0.70 to 1.42) 0.987 0.90 (0.62 to 1.31) 0.589 90-day mRS 0–3, n (%) 583 (56.5) 87 (59.2) 496 (56.1) 1.14 (0.80 to 1.62) 0.477 1.06 (0.73 to 1.54) 0.764 Successful recanalisation, n (%) 926 (89.7) 132 (89.8) 794 (89.7) 1.01 (0.57 to 1.80) 0.977 1.00 (0.51 to 1.93) 0.992 Complete recanalisation, n (%) 737 (71.4) 108 (73.5) 629 (71.1) 1.13 (0.76 to 1.67) 0.552 1.08 (0.71 to 1.66) 0.710 Safety outcomes SICH within 24 hours, n (%)* 82 (8.3) 7 (4.8) 75 (8.9) 0.52 (0.23 to 1.14) 0.098 0.59 (0.26 to 1.34) 0.205 PH within 24 hours, n (%)† 104 (10.4) 12 (8.2) 92 (10.8) 0.74 (0.39 to 1.38) 0.344 0.84 (0.43 to 1.62) 0.596 Any ICH within 24 hours, n (%)† 249 (25.0) 34 (23.3) 215 (25.3) 0.90 (0.59 to 1.36) 0.610 1.04 (0.67 to 1.60) 0.877 Mortality within 90 days, n (%) 145 (14.1) 17 (11.6) 128 (14.5) 0.77 (0.45 to 1.33) 0.349 0.83 (0.48 to 1.46) 0.518 * Forty-two missing data
†Thirty-six missing data
(c)OR, (common) OR; ICH, intracranial haemorrhage; LVO, large vessel occlusion; MeVO, medium vessel occlusion; mRS, modified Rankin Scale; PH, parenchymal haemorrhage; SICH, symptomatic intracranial haemorrhage.
- Table 3
Independent predictors of 90-day good outome in patients with MeVO (back stepwise logistics, p<0.05)
Predictors Or (95% CI) P value NLR ≤4.1 versus NLR >4.1 2.13 (1.14 to 3.99) 0.019 NIHSS ≤14 versus NIHSS >14 1.96 (1.02 to 3.80) 0.045 No. of MT passes ≤1 versus no. of MT passes >1 2.16 (1.14 to 4.11) 0.021 MeVO, medium vessel occlusion; MT, mechanical thrombectomy; NIHSS, National Institute of Health Stroke Scale; NLR, neutrophil-to-lymphocyte ratio.
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