Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes.
Publication/Presentation Date
12-1-2025
Abstract
OBJECTIVE: Mechanical thrombectomy (MT) is well established for large-vessel occlusion (LVO) strokes, but its safety in distal and medium-vessel occlusions (DMVOs) requires further investigation. This study analyzed the relationship between procedural approaches, petechial hemorrhage (PetH), and clinical outcomes in DMVO thrombectomy, with particular attention to technical considerations and the complex interplay between tissue injury and hemorrhagic complications.
METHODS: A retrospective cohort study was conducted on DMVO stroke patients treated with MT at 37 stroke centers worldwide from 2016 to 2024. Patients were categorized based on follow-up imaging into those with or without PetH. Four logistic regression models analyzed the association of PetH with favorable functional outcomes (modified Rankin Scale score ≤ 2) at 90 days, early neurological improvement (≥ 4-point National Institutes of Health Stroke Scale score decrease at 24 hours), all-cause mortality, and independent determinants of PetH. Adjusted odds ratios (aORs), 95% confidence intervals, and p values were reported.
RESULTS: Of 1428 patients, 439 (30.7%) developed PetH. Factors independently associated with PetH were multiple thrombectomy passes (aOR 1.58, 95% CI 1.21-2.06; p = 0.001), IV thrombolysis (aOR 1.31, 95% CI 1.01-1.69; p = 0.04), and the combined use of a stent retriever with aspiration as the first-line method compared with aspiration alone (aOR 1.66, 95% CI 1.15-2.38; p = 0.007). Conversely, general anesthesia (aOR 0.55, 95% CI 0.40-0.77; p < 0.001), higher Alberta Stroke Program Early CT Scores (aOR 0.76, 95% CI 0.69-0.83; p < 0.001), and successful recanalization (aOR 0.56, 95% CI 0.39-0.80; p = 0.002) were significantly associated with a lower odds of PetH. PetH was associated with a decreased odds of favorable functional outcomes (aOR 0.51, 95% CI 0.36-0.73; p < 0.001), reduced early neurological improvement (aOR 0.59, 95% CI 0.44-0.79; p < 0.001), and increased all-cause mortality (aOR 1.84, 95% CI 1.23-2.76; p < 0.001).
CONCLUSIONS: PetH is a frequent sequela following MT in DMVO strokes and is associated with poorer outcomes, likely reflecting underlying ischemic injury rather than direct causation. Procedural factors influence PetH risk, suggesting medical treatment as first-line therapy for DMVOs, with MT reserved for refractory cases using less aggressive approaches.
Volume
143
Issue
6
First Page
1501
Last Page
1513
ISSN
1933-0693
Published In/Presented At
Essibayi, M. A., Salim, H. A., Fazzari, M. J., Khatri, D., Baker, A., Musmar, B., Adeeb, N., Henninger, N., Sundararajan, S. H., Kühn, A. L., Khalife, J., Ghozy, S., Scarcia, L., Yeo, L. L. L., Tan, B. Y. Q., Regenhardt, R. W., Heit, J. J., Cancelliere, N. M., Rouchaud, A., Fiehler, J., … MAD MT Investigators (2025). Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes. Journal of neurosurgery, 143(6), 1501–1513. https://doi.org/10.3171/2025.3.JNS243030
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
40614268
Department(s)
Administration and Leadership
Document Type
Article