Predictors of distal embolization during thrombectomy for anterior circulation large vessel bifurcation occlusion stroke

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 in patients 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.