Medical Student Albert Einstein College of Medicine
Introduction: 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 examines the association between petechial hemorrhage (PetH) and clinical outcomes following MT in DMVO strokes and identifies factors associated with PetH.
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 (mRS ≤ 2) at 90 days, early neurological improvement (≥4-point NIHSS score decrease at 24 hours), all-cause mortality, and independent determinants of PetH. Adjusted odds ratios (aOR) and p-values were reported.
Results: Of 1,428 patients, 439 (30.7%) developed PetH. Factors independently associated with PetH were more likely after multiple thrombectomy passes (aOR 1.58, p=0.001), IV thrombolysis (OR 1.31, p=0.04), and the combined use of a stent retriever with aspiration as the first-line method compared to aspiration alone (aOR 1.66, p=0.007). Conversely, general anesthesia (aOR 0.55, p< 0.001), higher ASPECT scores (aOR 0.76, p< 0.001), and successful recanalization (aOR 0.56, p=0.002) were significantly associated with a lower risk of PetH. PetH was associated with a decreased likelihood of favorable functional outcomes (aOR 0.51, p< 0.001), reduced early neurological improvement (aOR 0.59, p< 0.001), and increased all-cause mortality (aOR 1.84, p< 0.001).
Conclusion : PetH is a frequent sequela following MT in DMVO strokes and is associated with poorer outcomes. Procedural factors such as thrombectomy technique and anesthesia type influence PetH risk, underscoring the need for careful patient selection and strategy optimization.
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