METHODS: We conducted a post-hoc analysis of the DIRECT-SAFE trial data, including patients with retrievable clots on the initial angiographic run. Patients were categorized into AF and non-AF groups. The primary outcome was the presence or absence of FPE (single-pass, single-device resulting in complete/near complete reperfusion) in AF and non-AF groups. We used multivariable logistic regression to examine the association between FPE and AF, adjusting for thrombolysis pre-thrombectomy and clot location.
RESULTS: We included 253 patients (67 with AF, 186 without AF). AF patients were older (mean age: 74 years vs 67.5 years, p=0.001), had a higher proportion of females (55% vs 40%, p=0.044), and experienced more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) score: 17 vs 14, p=0.009) than non-AF patients. No differences were observed in thrombolytic agent usage, time metrics, or clot location. AF patients achieved a higher proportion of FPE compared with non-AF patients (55.22% vs 37.3%, adjusted odds ratio 2.00 (95% CI 1.13 to 3.55), p=0.017).
CONCLUSIONS: AF-related strokes in LVO patients treated with EVT were associated with FPE. This highlights the need for preparedness for multiple passes and potential adjuvant/rescue therapy in non-AF-related strokes.
METHODS: This single-center retrospective study collected data from patients treated with FD between January 2016 and March 2024, including patient characteristics, aneurysm features, postoperative DWI lesions, and clinical outcomes. Vessel status was assessed using CFSS: 1a (normal caliber and flow), 1b (normal caliber, reduced flow), 2a (reduced caliber, normal flow), 2b (reduced caliber and flow), and 3 (occlusion).
RESULTS: Thirty-nine patients with 41 aneurysms with 63 covered MCA branches were included. Immediately after FD deployment, 63.5% of covered branches retained normal caliber and flow (CFSS 1a) while the remaining branches with compromised caliber and flow (CFSS >1a) showed significant improvement following tirofiban administration. Intraoperative thromboembolic complications led to occlusion in three branches, all restored after tirofiban without clinical symptoms (P=0.003). At 6 months, 79% of covered branches showed normal flow with or without caliber reduction (CFSS 1a/2a). DWI lesions showed no significant correlation with caliber and flow changes and clinical symptoms.
CONCLUSIONS: FD treatment for MCA aneurysms leads to significant but primarily asymptomatic CFSS changes in covered cortical branches within the first 6 months. Intra-arterial tirofiban effectively improves vessel status in branches with higher CFSS (>1a). CFSS is valuable for tracking these changes and underscores the importance of long-term follow-up.