|Paper title||Multi-vessel occlusion in patients subjected to thrombectomy: Prevalence, associated factors and clinical implications|
|Form of presentation||Poster|
Background: Patients with embolic large-vessel occlusion may present with additional co-incidental acute occlusions within or distant from the involved territory, referred to as multi-vessel occlusion (MVO).
Methods: Image data of consecutive endovascular candidates (n=720) with direct access to angiography were extracted from a prospective registry. Prevalence of MVO was assessed with multimodal MRI/CT and confirmed by intra-arterial angiography. Explorative analysis and clinical relevance was evaluated using multivariate logistic regression.
Results: MVO was present in 10.7% of patients (95%-CI 6.4-13.0%). Two, three and four concomitant occlusions were found in 80.5%, 16.9% and 2.6% of MVO cases, respectively. Detection rate on initial radiological report was 54.5%. Downstream MVO was present in around one-third of MVO (n=27/77, 35.1%), while all other MVO (n=50/77, 64.9%) occurred in different territories. Independent factors related to MVO were statin treatment (aOR 0.477, 95%-CI 0.276-0.827), higher systolic blood pressure (aOR per mmHg-increase 1.014, 95%-CI 1.005-1.023) and primary occlusion site M2 (aOR 1.870, 95%-CI 1.103-3.170). MVO was related to lower rates of successful reperfusion (aOR 0.549, 95%-CI 0.316-0.953) and poorer functional outcome (aOR 0.456, 95%-CI 0.224-0.930)
Conclusion: Every tenth patient subjected to angiography for endovascular stroke treatment experienced MVO in our series and only half were prospectively identified on pre-interventional diagnostic imaging. Patients with MVO had higher baseline systolic blood pressure and were less often medicated with statins, an observation which warrants external validation and evaluation regarding causality. Occurrence of MVO has implication for treatment decisions, negatively affects endovascular treatment success and is predictive of worse clinical outcome.