Predictors of distal embolization during thrombectomy for anterior circulation large vessel bifurcation occlusion stroke - Original research - Predictors identification

Sep 29, 2026

Distal embolization is a frequent complication of mechanical thrombectomy (MT) in acute ischemic stroke and is especially challenging at vascular bifurcations, yet its specific drivers in this setting remain insufficiently characterized. This retrospective study analyzed patients undergoing MT for anterior circulation large vessel bifurcation occlusion stroke from January 2015 to December 2023, evaluating baseline features, procedural variables, and clinical outcomes. Univariate and multivariable analyses identified independent predictors of distal embolization. ICA bifurcation occlusion, stent retriever thrombectomy, and more device passes increased risk.

LanguageEnglish

CategoryHealthcare

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Pages5

Reading Time13 min

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Abstract

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Ischemic stroke Neurology, Jinan University Affiliated Guangzhou Red Cross Hospital, Guangzhou, Guangdong, China Correspondence to Dr Hongxing Fan; fhxchina@ [126.com](126.com) YT and ZM contributed equally. YT and ZM are joint first authors. Received 24 August 2024 Accepted 3 October 2024 © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. To cite: Tan Y, Mao Z, Li Z, et al. J NeuroIntervent Surg Epub ahead of print: [please include Day Month Year] . doi:10 . 1136/jnis-2024- 022415 Original research Predictors of distal embolization during thrombectomy for anterior circulation large vessel bifurcation occlusion stroke Yanping Tan , Zhenlin Mao , Zhenhui Li , Hongxing Fan ABSTRACT Background Distal embolization is a frequent complication of mechanical thrombectomy (MT) for acute ischemic stroke, often leading to poor clinical outcomes. The vascular bifurcations represent a specialized anatomical location, thereby augmenting the complexity of MT. The specific factors contributing to distal embolization in this context have not been thoroughly explored. This study seeks to identify the factors associated with distal embolization during MT inpatients with anterior circulation large vessel bifurcation occlusion stroke. Methods A retrospective analysis was conducted on patients who underwent MT for acute anterior circulation bifurcation occlusion stroke between January 2015 and December 2023. Baseline characteristics, procedural details, and clinical outcomes were assessed. Univariate and multivariable analyses were performed to identify predictors of distal embolization during MT. Results The study included 119 patients. Univariate analysis revealed significant associations between distal embolization and occlusion location, internal carotid artery (ICA) tortuosity, first-line thrombectomy strategy, and the number of device passes. Multivariate analysis identified ICA bifurcation occlusions (odds ratio (OR) 3. 21, 95% confidence interval (CI) 1.188 to 8 .672, P=0.021), stent retriever thrombectomy (SRT) (OR 6. 177, 95% CI 1.77 to 21. 555, P=0 .004), and a higher number of device passes (OR 1. 778, 95% CI 1.132 to 2. 792, P=0 .013) as independent predictors of distal embolization. Conclusions ICA bifurcation occlusion, the use of SRT, and an increased number of device passes are significant predictors of distal embolization during MT in patients with anterior circulation large vessel bifurcation occlusion strokes. INTRODUCTION Mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke caused by large vessel occlusion (LVO) .1 However, thrombus fragmentation and distal embolization during endovascular therapy (EVT) are frequent complications that can negatively impact patient outcomes.2 3 Distal embolization during MT involves both emboli traveling to downstream areas of the targeted occlusion and to previously unaffected regions.4 Contributing factors include intravenous thrombolysis, balloon guide | WHAT IS ALREADY KNOWN ON THIS TOPIC | | --- | | ⇒ Distal embolization is a frequent complication of mechanical thrombectomy for acute ischemic stroke, often leading to poor clinical outcomes. The vascular bifurcations represent a specialized anatomical location, thereby augmenting the complexity of MT. The specific factors contributing to distal embolization in this context have not been thoroughly explored.
WHAT THIS STUDY ADDS | | ⇒ This retrospective review suggests that internal carotid artery bifurcation occlusion, stent retriever thrombectomy, and a greater number of device passes are linked to an elevated risk of distal emboli during MT for anterior circulation large vessel bifurcation occlusion strokes.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY | | ⇒ Our study suggests that the factors contributing to distal embolization associated with mechanical thr

FAQs

What is distal embolization in the context of mechanical thrombectomy?

Distal embolization refers to emboli moving to downstream regions beyond the targeted occlusion and to previously unaffected areas during endovascular therapy.

How was the study conducted and what time span was analyzed?

A retrospective analysis was performed on consecutive patients who underwent mechanical thrombectomy for acute anterior circulation bifurcation occlusion stroke between January 2015 and December 2023.

Which factors were identified as independent predictors of distal embolization?

Independent predictors included ICA bifurcation occlusion, stent retriever thrombectomy (SRT), and a higher number of device passes.

Sep 29, 2026

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