Endovascular Recanalization for Acute Internal Carotid Artery Terminus Occlusion: A Subgroup Analysis From the Direct-MT Trial

Abstract

BACKGROUND: The efficacy of endovascular recanalization for internal carotid artery (ICA) terminus occlusion has not been completely evaluated. OBJECTIVE: To investigate the efficacy of endovascular recanalization for ICA terminus occlusion. METHODS: Data from Direct-MT, a randomized controlled trial, were applied. ICA terminus occlusions were diagnosed with preprocedure computed tomography angiography by the core laboratory. We dichotomized the ICA terminus occlusions into 2 groups (non-T and T) and analyzed the differences between them. Single-factor analysis and multiple logistic regression were applied to detect independent factors for clinical outcomes and futile recanalization. RESULTS: The rates of first-pass effect, successful recanalization, good clinical outcome, mortality, and futile recanalization were 22.3% (50 of 224), 83.0% (181 of 224), 24.6% (55 of 224), 26.7% (60 of 224), and 69.6% (126 of 181), respectively. Baseline National Institutes of Health Stroke Scale (negative factor; odds ratio [OR] 0.89; 95% CI 0.84-0.95; P < 6 (OR 4.68; 95% CI 1.51-14.5; P =.007), tirofiban use (negative factor; OR 0.39; 95% CI 0.18-0.86; P =.020), and first-pass effect (negative factor; OR 0.44; 95% CI 0.19-0.99; P =.047) were independent factors for futile recanalization. CONCLUSION: More efforts in modifiable factors should be made to improve the efficacy of endovascular recanalization for better clinical outcomes and less futile recanalization in ICA terminus occlusions.