Chinese Expert Consensus on the Management of Medium Vessel Occlusion in Acute Ischemic Stroke 2024

doi:10.3969/j.issn.1673-5765.2024.11.011

Abstract

Abstract: Chinese Expert Consensus on the Management of Medium Vessel Occlusion in Acute Ischemic Stroke 2024 is a summary and analysis conducted by experts organized by the Chinese Interventional Neuroradiology Society of Chinese Stroke Association, based on recent advancements and new evidence-based medical findings in the field of endovascular treatment for acute intracranial medium vessel occlusion. This consensus covers the definition of intracranial medium vessels, the incidence, prognosis, diagnosis, intravenous thrombolysis/intra-arterial thrombolysis, endovascular treatment, and specific techniques of endovascular treatment. The aim is to provide guidance for professionals and social workers engaged in stroke prevention and treatment, especially those specializing in endovascular treatment, nursing, and rehabilitation of acute ischemic stroke, as well as relevant governmental agencies, healthcare administrators, pharmaceutical companies, healthcare demand parties, and other stakeholders.

Key words: Endovascular treatment; Medium vessel occlusion; Ischemic stroke; Expert consensus; Evidence; Recommendation

摘要： 《急性缺血性卒中中等血管闭塞管理中国专家共识2024》是由中国卒中学会神经介入分会组织专家根据近年来血管内治疗急性颅内中等血管闭塞领域研究的新进展和新的循证医学证据进行的分析和总结。此次共识编写涵盖颅内中等血管的定义，中等血管闭塞的发病率、预后、诊断、静脉/动脉溶栓治疗、血管内治疗以及具体的血管内治疗技术等内容，旨在为从事卒中防治尤其是急性缺血性卒中血管内治疗、护理及康复的相关专业人员和社会工作者，以及政府相关管理机构、卫生事业管理人员、医药企业、卫生保健需求方和其他利益相关者提供指导意见。

关键词: 血管内治疗; 中等血管闭塞; 缺血性卒中; 专家共识; 证据; 推荐

CLC Number:

Chinese Interventional Neuroradiology Society of Chinese Stroke Association. Chinese Expert Consensus on the Management of Medium Vessel Occlusion in Acute Ischemic Stroke 2024[J]. Chinese Journal of Stroke, 2024, 19(11): 1333-1358.

中国卒中学会神经介入分会. 急性缺血性卒中中等血管闭塞管理中国专家共识2024[J]. 中国卒中杂志, 2024, 19(11): 1333-1358.

References

[1] GROSSBERG J A，REBELLO L C，HAUSSEN D C，et al. Beyond large vessel occlusion strokes：distal occlusion thrombectomy[J]. Stroke，2018，49（7）：1662-1668.
[2] MISTRY E A，DUMONT A S. Medium vessel occlusion and acute ischemic stroke：a call for treatment paradigm reappraisal[J]. Stroke，2020，51（11）：3200-3202.
[3] OSPEL J M，MENON B K，DEMCHUK A M，et al. Clinical course of acute ischemic stroke due to medium vessel occlusion with and without intravenous alteplase treatment[J]. Stroke，2020，51（11）：3232-3240.
[4] PÉREZ-GARCÍA C，MOREU M，ROSATI S，et al. Mechanical thrombectomy in medium vessel occlusions：blind exchange with mini-pinning technique versus mini stent retriever alone[J]. Stroke，2020，51（11）：3224-3231.
[5] SAVER J L，CHAPOT R，AGID R，et al. Thrombectomy for distal，medium vessel occlusions：a consensus statement on present knowledge and promising directions[J]. Stroke，2020，51（9）：2872-2884.
[6] GOYAL M，OSPEL J M，MENON B K，et al. MeVO：the next frontier？[J]. J Neurointerv Surg，2020，12（6）：545-547.
[7] MENON B K，HILL M D，DAVALOS A，et al. Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions：meta-analysis of data from the HERMES collaboration[J]. J Neurointerv Surg，2019，11（11）：1065-1069.
[8] KOBEISSI H，BILGIN C，GHOZY S，et al. A review of acute ischemic stroke caused by distal，medium vessel occlusions[J/OL]. Interv Neuroradiol，2023：15910199231197616[2024-10-11]. https://doi.org/10.1177/15910199231197616.
[9] HELDNER M R，HSIEH K，BROEG-MORVAY A，et al. Clinical prediction of large vessel occlusion in anterior circulation stroke：mission impossible？[J]. J Neurol，2016，263（8）：1633-1640.
[10] RAI A T，DOMICO J R，BUSEMAN C，et al. A population-based incidence of M2 strokes indicates potential expansion of large vessel occlusions amenable to endovascular therapy[J]. J Neurointerv Surg，2018，10（6）：510-515.
[11] SMITH W S，LEV M H，ENGLISH J D，et al. Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA[J]. Stroke，2009，40（12）：3834-3840.
[12] ZHAO H，COOTE S，PESAVENTO L，et al. Large vessel occlusion scales increase delivery to endovascular centers without excessive harm from misclassifications[J]. Stroke，2017，48（3）：568-573.
[13] DULOQUIN G，GRABER M，GARNIER L，et al. Incidence of acute ischemic stroke with visible arterial occlusion：a population-based study（Dijon stroke registry）[J]. Stroke，2020，51（7）：2122-2130.
[14] PISCOPO A，ZANATY M，DLOUHY K. Contemporary methods for detection and intervention of distal medium and small vessel occlusions[J/OL]. J Clin Med，2023，12（18）：6071[2024-10-11]. https://doi.org/10.3390/jcm12186071.
[15] KAESMACHER J，MAEGERLEIN C，KAESMACHER M，et al. Thrombus migration in the middle cerebral artery：incidence，imaging signs，and impact on success of endovascular thrombectomy[J/OL]. J Am Heart Assoc，2017，6（2）：e005149[2024-10-11]. https://doi.org/10.1161/jaha.116.005149.
[16] GOYAL M，KAPPELHOF M，MCDONOUGH R，et al. Secondary medium vessel occlusions：when clots move north[J]. Stroke，2021，52（3）：1147-1153.
[17] OSPEL J M，CIMFLOVA P，MARKO M，et al. Prevalence and outcomes of medium vessel occlusions with discrepant infarct patterns[J]. Stroke，2020，51（9）：2817-2824.
[18] LIU M，NASR D，BRINJIKJI W. The incidence of medium vessel occlusions：a population-based study[J/OL]. Front Neurol，2023，14：1225066[2024-10-11]. https://doi.org/10.3389/fneur.2023.1225066.
[19] LIMA F O，FURIE K L，SILVA G S，et al. Prognosis of untreated strokes due to anterior circulation proximal intracranial arterial occlusions detected by use of computed tomography angiography[J]. JAMA Neurol，2014，71（2）：151-157.
[20] SHETH S A，YOO B，SAVER J L，et al. M2 occlusions as targets for endovascular therapy：comprehensive analysis of diffusion/perfusion MRI，angiography，and clinical outcomes[J]. J Neurointerv Surg，2015，7（7）：478-483.
[21] FASEN B A C M，HEIJBOER R J J，HULSMANS F J H，et al. CT angiography in evaluating large-vessel occlusion in acute anterior circulation ischemic stroke：factors associated with diagnostic error in clinical practice[J]. AJNR Am J Neuroradiol，2020，41（4）：607-611.
[22] KUNZ W G，SOMMER W H，HAVLA L，et al. Detection of single-phase CTA occult vessel occlusions in acute ischemic stroke using CT perfusion-based wavelet-transformed angiography[J]. Eur Radiol，2017，27（6）：2657-2664.
[23] MATTERN H，SCIARRA A，GODENSCHWEGER F，et al. Prospective motion correction enables highest resolution time-of-flight angiography at 7 T[J]. Magn Reson Med，2018，80（1）：248-258.
[24] PARK C A，KANG C K，KIM Y B，et al. Advances in MR angiography with 7 T MRI：from microvascular imaging to functional angiography[J/OL]. Neuroimage，2018，168：269-278[2024-10-11]. https://doi.org/10.1016/j.neuroimage.2017.01.019.
[25] AMUKOTUWA S A，WU A，ZHOU K，et al. Distal medium vessel occlusions can be accurately and rapidly detected using Tmax maps[J]. Stroke，2021，52（10）：3308-3317.
[26] BECKS M J，MANNIESING R，VISTER J，et al. Brain CT perfusion improves intracranial vessel occlusion detection on CT angiography[J]. J Neuroradiol，2019，46（2）：124-129.
[27] SOUSA J A，SONDERMANN A，BERNARDO-CASTRO S，et al. CTA and CTP for detecting distal medium vessel occlusions：a systematic review and meta-analysis[J]. AJNR Am J Neuroradiol，2023，45（1）：51-56.
[28] DUVEKOT M H C，VAN ES A C G M，VENEMA E，et al. Accuracy of CTA evaluations in daily clinical practice for large and medium vessel occlusion detection in suspected stroke patients[J]. Eur Stroke J，2021，6（4）：357-366.
[29] GUPTA A，GARG P K，KHERA P S，et al. Multiphase computed tomography angiography（mCTA）derived source images in acute ischemic stroke：beyond collaterals. Can it obviate the need for computed tomography perfusion（CTP）？[J/OL]. Clin Neurol Neurosurg，2022，222：107421[2024-10-11]. https://doi.org/10.1016/j.clineuro.2022.107421.
[30] AMUKOTUWA S A，WU A，ZHOU K，et al. Time-to-maximum of the tissue residue function improves diagnostic performance for detecting distal vessel occlusions on CT angiography[J]. AJNR Am J Neuroradiol，2021，42（1）：65-72.
[31] ALOTAIBI F F，ALSHAHRANI A，MOHAMED G，et al. Diagnostic accuracy of large and medium vessel occlusions in acute stroke imaging by neurology residents and stroke fellows：a comparison of CT angiography alone and CT angiography with CT perfusion[J]. Eur Stroke J，2024，9（2）：356-365.
[32] MOHAMMADEN M H，DOHEIM M F，ELFIL M，et al. Direct to angiosuite versus conventional imaging in suspected large vessel occlusion：a systemic review and meta-analysis[J]. Stroke，2022，53（8）：2478-2487.
[33] REQUENA M，OLIVÉ-GADEA M，MUCHADA M，et al. Direct to angiography suite without stopping for computed tomography imaging for patients with acute stroke：a randomized clinical trial[J]. JAMA Neurol，2021，78（9）：1099-1107.
[34] SENERS P，TURC G，MAÏER B，et al. Incidence and predictors of early recanalization after intravenous thrombolysis：a systematic review and meta-analysis[J]. Stroke，2016，47（9）：2409-2412.
[35] MENON B K，AL-AJLAN F S，NAJM M，et al. Association of clinical，imaging，and thrombus characteristics with recanalization of visible intracranial occlusion in patients with acute ischemic stroke[J]. JAMA，2018，320（10）：1017-1026.
[36] YOO J，BAEK J H，PARK H，et al. Thrombus volume as a predictor of nonrecanalization after intravenous thrombolysis in acute stroke[J]. Stroke，2018，49（9）：2108-2115.
[37] FURLAN A，HIGASHIDA R，WECHSLER L，et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT Ⅱ study：a randomized controlled trial. Prolyse in acute cerebral thromboembolism[J]. JAMA，1999，282（21）：2003-2011.
[38] SARRAJ A，SANGHA N，HUSSAIN M S，et al. Endovascular therapy for acute ischemic stroke with occlusion of the middle cerebral artery M2 segment[J]. JAMA Neurol，2016，73（11）：1291-1296.
[39] QURESHI A I，SALEEM M A，AYTAC E. Comparison of endovascular treatment with intravenous thrombolysis for isolated M2 segment of middle cerebral artery occlusion in acute ischemic stroke[J]. J Vasc Interv Neurol，2017，9（5）：8-14.
[40] MEYER L，STRACKE C P，JUNGI N，et al. Thrombectomy for primary distal posterior cerebral artery occlusion stroke：the TOPMOST study[J]. JAMA Neurol，2021，78（4）：434-444.
[41] WANG J，QIAN J C，FAN L，et al. Efficacy and safety of mechanical thrombectomy for M2 segment of middle cerebral artery：a systematic review and meta-analysis[J]. J Neurol，2021，268（7）：2346-2354.
[42] SABER H，DESAI S M，HAUSSEN D，et al. Endovascular therapy vs. medical management for patients with acute stroke with medium vessel occlusion in the anterior circulation[J/OL]. JAMA Netw Open，2022，5（10）：e2238154[2024-10-11]. https://doi.org/10.1001/jamanetworkopen.2022.38154.
[43] MARCHAL A，BRETZNER M，CASOLLA B，et al. Endovascular thrombectomy for distal medium vessel occlusions of the middle cerebral artery：a safe and effective procedure[J/OL]. World Neurosurg，2022，160：e234-e241[2024-10-11]. https://doi.org/10.1016/j.wneu.2021.12.113.
[44] MEYER L，STRACKE P，BROOCKS G，et al. Thrombectomy versus medical management for isolated anterior cerebral artery stroke：an international multicenter registry study[J/OL]. Radiology，2023，307（2）：e220229[2024-10-11]. https://doi.org/10.1148/radiol.220229.
[45] LOH E W，TOH K Z X，KWOK G Y R，et al. Endovascular therapy for acute ischemic stroke with distal medium vessel occlusion：a systematic review and meta-analysis[J/OL]. J Neurointerv Surg，2023，15（e3）：e452-e459[2024-10-11]. https://doi.org/10.1136/jnis-2022-019717.
[46] KIM C H，KIM S E，JEON J P. Meta-analysis of endovascular treatment for acute M2 occlusion[J]. J Korean Neurosurg Soc，2019，62（2）：193-200.
[47] NAKANO T，SHIGETA K，OTA T，et al. Efficacy and safety of mechanical thrombectomy for occlusion of the second segment of the middle cerebral artery：retrospective analysis of the Tama-registry of acute endovascular thrombectomy（TREAT）[J]. Clin Neuroradiol，2020，30（3）：481-487.
[48] JUMAA M A，CASTONGUAY A C，SALAHUDDIN H，et al. Middle cerebral artery M2 thrombectomy in the STRATIS registry[J]. Stroke，2021，52（11）：3490-3496.
[49] SHEK K，ALCOCK S，GHROODA E，et al. Effectiveness and safety of endovascular thrombectomy for large versus medium vessel occlusions：a single-center experience[J/OL]. J Neurointerv Surg，2022，14（5）：neurintsurg-2021-017502[2024-10-11]. https://doi.org/10.1136/neurintsurg-2021-017502.
[50] SUN D P，LIU R，HUO X C，et al. Endovascular treatment for acute ischaemic stroke due to medium vessel occlusion：data from ANGEL-ACT registry[J]. Stroke Vasc Neurol，2022，8（1）：51-58.
[51] GROSSBERG J A，CHALHOUB R M，AL KASAB S，et al. Multicenter investigation of technical and clinical outcomes after thrombectomy for proximal medium vessel occlusion（pMeVO）by frontline technique[J]. Interv Neuroradiol，2024，30（4）：470-479.
[52] HERZBERG M，DORN F，TRUMM C，et al. Middle cerebral artery M2 thrombectomy：safety and technical considerations in the German stroke registry（GSR）[J/OL]. J Clin Med，2022，11（15）：4619[2024-10-11]. https://doi.org/10.3390/jcm11154619.
[53] SCHULZE-ZACHAU V，BREHM A，NTOULIAS N，et al. Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion thrombectomy[J]. J Neurointerv Surg，2024，16（8）：775-780.
[54] CASCIO RIZZO A，SCHWARZ G，CERVO A，et al. Safety and efficacy of endovascular thrombectomy for primary and secondary MeVO[J/OL]. J Stroke Cerebrovasc Dis，2024，33（1）：107492[2024-10-11]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107492.
[55] COUTINHO J M，LIEBESKIND D S，SLATER L A，et al. Mechanical thrombectomy for isolated M2 occlusions：a post hoc analysis of the STAR，SWIFT，and SWIFT PRIME studies[J]. AJNR Am J Neuroradiol，2016，37（4）：667-672.
[56] BHOGAL P，BÜCKE P，AGUILAR PÉREZ M，et al. Mechanical thrombectomy for M2 occlusions：a single-centre experience[J]. Interv Neurol，2017，6（3/4）：117-125.
[57] CHEN C J，WANG C，BUELL T J，et al. Endovascular mechanical thrombectomy for acute middle cerebral artery M2 segment occlusion：a systematic review[J/OL]. World Neurosurg，2017，107：684-691[2024-10-11]. https://doi.org/10.1016/j.wneu.2017.08.108.
[58] SABER H，NARAYANAN S，PALLA M，et al. Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery：a meta-analysis[J]. J Neurointerv Surg，2018，10（7）：620-624.
[59] COMPAGNE K C J，VAN DER SLUIJS P M，VAN DEN WIJNGAARD I R，et al. Endovascular treatment：the role of dominant caliber M2 segment occlusion in ischemic stroke[J]. Stroke，2019，50（2）：419-427.
[60] CAPPELLARI M，SAIA V，PRACUCCI G，et al. Different endovascular procedures for stroke with isolated M2-segment MCA occlusion：a real-world experience[J]. J Thromb Thrombolysis，2021，51（4）：1157-1162.
[61] WANG M，FAROUKI Y，HULSCHER F，et al. Early neurological improvement predicts clinical outcome after thrombectomy for distal medium vessel occlusions[J/OL]. Front Neurol，2022，13：809066[2024-10-11]. https://doi.org/10.3389/fneur.2022.809066.
[62] MEYER L，STRACKE C P，WALLOCHA M，et al. Thrombectomy for secondary distal，medium vessel occlusions of the posterior circulation：seeking complete reperfusion[J]. J Neurointerv Surg，2022，14（7）：654-659.
[63] MUSZYNSKI P，ANADANI M，RICHARD S，et al. Endovascular reperfusion of M2 occlusions in acute ischemic stroke reduced disability and mortality：ETIS registry results[J/OL]. J Neurointerv Surg，2022，14（5）：neurintsurg-2021-017380[2024-10-11]. https://doi.org/10.1136/neurintsurg-2021-017380.
[64] ALAWIEH A M，CHALHOUB R M，AL KASAB S，et al. Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique[J/OL]. J Neurointerv Surg，2023，15（e1）：e93-e101[2024-10-11]. https://doi.org/10.1136/jnis-2022-019023.
[65] KNIEP H，MEYER L，BROOCKS G，et al. Predictors of functional outcome after thrombectomy for M2 occlusions：a large scale experience from clinical practice[J/OL]]. Sci Rep，2023，13（1）：18740[2024-10-11]. https://doi.org/10.1038/s41598-023-45232-x.
[66] WINKELMEIER L，HEITKAMP C，FAIZY T D，et al. Prognostic value of recanalization attempts in endovascular therapy for M2 segment middle cerebral artery occlusions[J]. Int J Stroke，2024，19（4）：422-430.
[67] RADU R A，COSTALAT V，FAHED R，et al. First pass effect as an independent predictor of functional outcomes in medium vessel occlusions：an analysis of an international multicenter study[J]. Eur Stroke J，2024，9（1）：114-123.
[68] RODRIGUEZ-CALIENES A，VIVANCO-SUAREZ J，SEQUEIROS J M，et al. Mechanical thrombectomy for the treatment of primary and secondary distal medium-vessel occlusion stroke：systematic review and meta-analysis[J/OL]. J Neurointerv Surg，2023，15（e3）：e460-e467[2024-10-11]. https://doi.org/doi:10.1136/jnis-2022-019975.
[69] NOME T，ENRIQUEZ B，NOME C G，et al. Clinical outcome after thrombectomy in patients with MeVO stroke：importance of clinical and technical factors[J]. J Neurol，2024，271（2）：877-886.
[70] RIZZO F，ROMOLI M，SIMONETTI L，et al. Reperfusion strategies in stroke with medium-to-distal vessel occlusion：a prospective observational study[J]. Neurol Sci，2024，45（3）：1129-1134.
[71] FAROUKI Y，BONNET T，MINE B，et al. First-pass effect predicts clinical outcome and infarct growth after thrombectomy for distal medium vessel occlusions[J]. Neurosurgery，2022，91（6）：913-919.
[72] GORY B，LAPERGUE B，BLANC R，et al. Contact aspiration versus stent retriever in patients with acute ischemic stroke with M2 occlusion in the ASTER randomized trial（contact aspiration versus stent retriever for successful revascularization）[J]. Stroke，2018，49（2）：461-464.
[73] PHAN K，MAINGARD J，KOK H K，et al. Contact aspiration versus stent-retriever thrombectomy for distal middle cerebral artery occlusions in acute ischemic stroke：meta-analysis[J]. Neurointervention，2018，13（2）：100-109.
[74] ATCHANEEYASAKUL K，MALIK A M，YAVAGAL D R，et al. Thrombectomy outcomes in acute ischemic stroke due to middle cerebral artery M2 occlusion with stent retriever versus aspiration：a multicenter experience[J]. Interv Neurol，2020，8（2/6）：180-186.
[75] BERNSEN M L E，GOLDHOORN R-J B，LINGSMA H F，et al. Importance of occlusion site for thrombectomy technique in stroke：comparison between aspiration and stent retriever[J]. Stroke，2021，52（1）：80-90.
[76] MEYER L，STRACKE P，WALLOCHA M，et al. Aspiration versus stent retriever thrombectomy for distal，medium vessel occlusion stroke in the posterior circulation：a subanalysis of the TOPMOST study[J]. Stroke，2022，53（8）：2449-2457.
[77] TOH K Z X，KOH M Y，LOH E W，et al. Distal medium vessel occlusions in acute ischaemic stroke -stent retriever versus direct aspiration：a systematic review and meta-analysis[J]. Eur Stroke J，2023，8（2）：434-447.
[78] BILGIN C，HARDY N，HUTCHISON K，et al. First-line thrombectomy strategy for distal and medium vessel occlusions：a systematic review[J]. J Neurointerv Surg，2023，15（6）：539-546.
[79] RENIERI L，VALENTE I，DMYTRIW A A，et al. Mechanical thrombectomy beyond the circle of Willis：efficacy and safety of different techniques for M2 occlusions[J]. J Neurointerv Surg，2022，14（6）：546-550.
[80] NAVIA P，LARREA J A，PARDO E，et al. Initial experience using the 3MAX cerebral reperfusion catheter in the endovascular treatment of acute ischemic stroke of distal arteries[J]. J Neurointerv Surg，2016，8（8）：787-790.
[81] CROCKETT M T，PHILLIPS T J，CHIU A H Y. Dual suction Headway27 microcatheter thrombectomy for the treatment of distal intracranial arterial occlusion strokes：initial experience with the micro-ADAPT technique[J].
J Neurointerv Surg，2019，11（7）：714-718.
[82] ROMANO D G，FRAUENFELDER G，CARAGLIANO A，et al. Multicentric experience with an intermediate aspiration catheter for distal M2 ischemic stroke[J/OL]. J Stroke Cerebrovasc Dis，2020，29（12）：105389[2024-10-11]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105389.
[83] YOSHIMOTO T，TANAKA K，KOGE J，et al. Blind exchange with mini-pinning technique using the tron stent retriever for middle cerebral artery M2 occlusion thrombectomy in acute ischemic stroke[J/OL]. Front Neurol，2021，12：667835[2024-10-11]. https://doi.org/10.3389/fneur.2021.667835.
[84] GUENEGO A，MINE B，BONNET T，et al. Thrombectomy for distal medium vessel occlusion with a new generation of stentretriever（Tigertriever 13）[J]. Interv Neuroradiol，2022，28（4）：444-454.
[85] GOERTZ L，WEISS D，ABDULLAYEV N，et al. Safety and efficacy of the novel low-profile APERIO Hybrid17 for a treatment of proximal and distal vessel occlusion in acute ischemic stroke：a multi-center experience[J/OL]. World Neurosurg，2022，167：e386-e396[2024-10-11]. https://doi.org/10.1016/j.wneu.2022.08.023.
[86] FISCHER S，WILL L，PHUNG T，et al. The Tigertriever 13 for mechanical thrombectomy in distal and medium intracranial vessel occlusions[J]. Neuroradiology，2022，64（4）：775-783.
[87] GRIEB D，GRELING B，SCHULZ K，et al. Endovascular treatment of distal medium vessel occlusions using microcatheter aspiration thrombectomy[J]. Interv Neuroradiol，2024，30（2）：234-241.
[88] ZHAO C H，KONERU M，SIEGLER J E，et al. Single center experience using 3 mm Trevo stent retrievers in medium vessel occlusion thrombectomy[J/OL]. Interv Neuroradiol，2023：15910199231199880[2024-10-11]. https://doi.org/10.1177/15910199231199880.
[89] NTOULIAS N，BREHM A，TSOGKAS I，et al. Initial experience with the Solitaire X 3 mm stent retriever for the treatment of distal medium vessel occlusions[J/OL]. J Clin Med，2023，12（23）：7289[2024-10-11]. https://doi.org/10.3390/jcm12237289.
[90] PSYCHOGIOS M N，TSOGKAS I，BLACKHAM K，et al. The Quattro technique for medium distal vessel occlusion stroke[J]. Clin Neuroradiol，2024，34（1）：257-262.
[91] ORSCELIK A，KALLMES D F，BILGIN C，et al. Comparison of balloon guide catheter versus non-balloon guide catheter for mechanical thrombectomy in patients with distal medium vessel occlusion[J]. J Neurointerv Surg，2024，16（6）：587-594.
[92] MONTEIRO A，MAKALANDA H L D，WAREHAM J，et al. Mechanical thrombectomy in medium vessel occlusions using the novel aspiration Q catheters：an international multicenter experience[J]. J Neurointerv Surg，2024，16（6）：603-607.
[93] ADUSUMILLI G，KOBEISSI H，GHOZY S，et al. Comparing Tigertriever 13 to other thrombectomy devices for distal medium vessel occlusion：a systematic review and meta-analysis[J/OL]. Interv Neuroradiol，2023：15910199231152510[2024-10-11]. https://doi.org/10.1177/15910199231152510.
[94] HAUSSEN D C，AL-BAYATI A R，EBY B，et al. Blind exchange with mini-pinning technique for distal occlusion thrombectomy[J]. J Neurointerv Surg，2020，12（4）：392-395.
[95] MEYER L，STRACKE C P，BROOCKS G，et al. Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery[J]. J Neurointerv Surg，2024，16（3）：230-236.