About

Brett L. Cucchiara, MD, is a Professor of Neurology at the Hospital of the University of Pennsylvania and serves as the Director of the Neurovascular Ultrasound Laboratory at the same institution. His department affiliation is with Neurology at the University of Pennsylvania. Dr. Cucchiara's research involves studying blood biomarkers in patients with transient ischemic attack (TIA), stroke, and other cerebrovascular diseases, as well as examining alterations in vascular structure and function in patients with migraine. He also utilizes transcranial Doppler emboli detection for the assessment of patients with cerebrovascular conditions. His clinical expertise includes cerebrovascular disease, stroke, TIA, intracerebral hemorrhage, carotid stenosis, arterial dissection, and transcranial Doppler. Dr. Cucchiara has contributed to the field through numerous publications and is actively involved in research that advances understanding of cerebrovascular pathology and diagnostics.

Research topics

• Medicine
• Internal medicine
• Cardiology
• Sociology
• Surgery
• Medical education
• Family medicine
• Emergency medicine
• Gastroenterology
• Virology
• Intensive care medicine
• Medical emergency
• Nursing

Selected publications

• Abstract WP244: Complex Aortic Plaque on Computed Tomography Angiography in Embolic Stroke of Undetermined Source: Association with Multiple Strokes

  Stroke · 2026-01-29

  article

  Purpose: Complex aortic plaque (CAP), an underrecognized source of embolic stroke, lacks standardized CT criteria. We evaluated the prevalence of CAP on routine CTA at different thresholds of maximal plaque thickness (MPT) and additionally capturing low attenuation plaque and ulceration in patients with embolic stroke of undetermined source (ESUS). We assessed the association between CAP and history of prior strokes before the index ESUS. Materials and Methods: This retrospective single-center study reviewed consecutive patients with unilateral anterior circulation ESUS who underwent neck CTA including the aortic arch (ascending/arch/descending). The aortic arch was inspected for hypoattenuating plaques on axial and reformatted images by a radiologist. MPT was measured orthogonal to plaque. Plaques were manually segmented using 3D Slicer to record median attenuation in Hounsfield units (HU). CAP definitions included MPT ≥3 mm, ≥4 mm, HU ≤80, and combined criteria (MPT ≥4 mm or HU ≤80, with or without ulceration ≥2 mm). Attenuation of ≥4 vs. <4 mm plaques was compared by Welch’s t-test. Age, sex and vascular risk factors (hypertension, diabetes, hyperlipidemia, smoking) were compared between CAP and non-CAP groups using Chi-square or Fisher’s exact test. Primary outcome was multiple strokes, defined as a history of prior stroke and current index ESUS. Results: Of 143 ESUS patients, 133 (mean age 65±13 years; 70 women; baseline NIHSS 8±7) met inclusion. CAP prevalence was 15.7% with a ≥3 mm threshold, 6.0% by ≥4 mm, 7.5% by ≤80 HU, and 6.0% by ulceration; combined criteria (≥4 mm, ulceration, or ≤80 HU) yielded 10.5%. CAP ≥4 mm was significantly associated with multiple strokes (4/8 vs. 14/125; OR 7.9, p=0.012). With combined criteria, the association also remained significant (5/14 vs. 13/119; OR 4.5, p=0.024), capturing additional high-risk patients beyond the ≥4 mm cutoff. Plaques ≥4 mm had lower attenuation than smaller plaques (53±26 vs. 107±54 HU; p=0.006). Patients with ≥4 mm CAP were older (79 vs. 64 years; p=0.001) and did not differ by sex or other risk factors. Conclusion: CTA-detected CAP was present in 6–16% of ESUS patients. Plaque ≥4 mm and broader high-risk definition (≥4 mm, ≤80 HU, or ulceration) was significantly associated with multiple strokes. Aortic arch assessment on routine neck CTA may enhance detection of potential aortic embolic sources.

  PublisherDOI

• Role of CT Perfusion Imaging in Patients With Minor Stroke: A Cohort Study

  The Neurohospitalist · 2026-01-30

  articleOpen access

  Background: CTP has increasingly been incorporated into the evaluation of all patients with suspected acute ischemic stroke (AIS), including those with minor symptoms. We aimed to assess the frequency with which CTP is performed in patients with possible AIS based on NIHSS as well as the role of CTP in acute treatment decision-making among patients with low NIHSS. Methods: We performed a retrospective cohort study of all patients who underwent CTP upon presentation to the ED at 3 academic, urban hospitals in Philadelphia, PA between January 1, 2022 and December 31, 2022. We collected data on initial NIHSS score, AIS treatment decisions, subsequent neuroimaging, and final diagnosis. The study was deemed exempt by the Hospital of the University of Pennsylvania IRB. Results: There were 530 patients with a median age of 65 years (IQR 54-73) and 56% were women. The frequency of CTP by NIHSS is displayed in the figure. A total of 89 CTP studies (16.8%) were performed in patients with very low NIHSS (defined as NIHSS ≤ 2). Of these, just 2 (2.2%) received thrombolysis and 0 (0%) received thrombectomy. CTP did not influence the treatment decision in either case. Conclusions: CTP is frequently performed in patients with low NIHSS. It had limited impact on acute treatment decisions, notably none among those with NIHSS ≤ 2, suggesting that CTP may be over-utilized in this subset of patients with AIS.

  PublisherOA PDFDOI

• Neuroimaging features of cerebral air embolism: a matched case-control study

  American Journal of Neuroradiology · 2026-02-16

  articleOpen accessSenior author

  BACKGROUND AND PURPOSE: Cerebral air embolism (CAE) is a rare but treatable cause of ischemic stroke. Clinically, CAE may be difficult to distinguish from stroke due to more typical thromboembolic causes, but accurate diagnosis is critical to initiate appropriate treatment. We aimed to define the imaging features of CAE by comparing MRI from patients with confirmed CAE to those in cardioembolic stroke due to atrial fibrillation (AF). MATERIALS AND METHODS: In a retrospective, matched case-control study, CAE cases from 2012-2023 were matched 1:2 by presenting NIHSS to control patients who had stroke due to AF and were not treated with thrombolytics or thrombectomy. MRIs were reviewed by a neuroradiologist blinded to group. The primary outcome was presence of pre-specified neuroimaging features on MRI. RESULTS: Fourteen patients with stroke due to CAE (median age 61, 64% female, median NIHSS 12) and 28 controls with stroke due to AF (median age 81, 43% female, median NIHSS 12) were included. The predominant infarction topography in CAE patients was gyriform in 86%, punctate in 7%, and wedge-shaped in 7%, whereas in patients with stroke due to AF the predominant infarction topography was wedge-shaped in 71%, punctate in 18%, and gyriform in 11% (p<0.001). CAE patients more often presented with multiple (93% versus 50%, p=0.007) and bilateral infarctions (79% versus 43%, p=0.05). Cortical borderzone involvement was more frequent in patients with CAE compared to those with AF (86% versus 25%, p<0.001). The presence of both predominantly gyriform infarction topography and cortical borderzone involvement had a 76.6% sensitivity and 96.4% specificity for CAE. CONCLUSIONS: CAE cause characteristic gyriform infarction patterns on MRI that are distinct from typical cardioembolic stroke. In addition, cortical borderzone predilection and multifocal infarctions were substantially more frequent in CAE. This constellation of findings, in the appropriate clinical context, should strongly suggest CAE as the mechanism of neurologic injury, and may facilitate timely identification of this uncommon but critical diagnosis.

  PublisherDOI

• Impact of intravenous thrombolysis on aspiration thrombectomy outcomes: an Imperative Trial subgroup analysis

  Journal of NeuroInterventional Surgery · 2026-05-05

  article

  BACKGROUND: The impact of intravenous (IV) thrombolysis on the outcomes of aspiration thrombectomy as the primary endovascular approach to stroke in patients with large vessel occlusion is unknown. METHODS: The Imperative Trial was a prospective, investigational device exemption, multicenter trial of first-line aspiration thrombectomy that assessed the safety and efficacy of the Zoom System, including a novel 0.088 inch aspiration catheter in patients with stroke within 8 hours of onset. We compared procedural, technical, and clinical outcomes of aspiration thrombectomy based on whether patients had received IV thrombolytics prior to the intervention. RESULTS: Among the 260 patients treated with front-line aspiration thrombectomy using the Zoom System, 125 (48%) received IV thrombolysis prior to aspiration. Rates of modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b achieved with the Zoom System were higher in the aspiration-only group than in the combined group (92% vs 81%, P=0.016). Rates of mTICI ≥2c and first pass effect were similar. The use of rescue devices to achieve mTICI ≥2b was less frequent in the aspiration-only group than in the combined group (2% vs 10%, P=0.008). The rates of functional independence (modified Rankin Scale (mRS) score 0-2) in the aspiration-only group and the combined group were 50% and 59%, respectively (P=0.16). Univariate (P=0.30) and multivariate (P=0.47) ordinal regression analyses showed no significant correlation of mRS 0-2 with IV thrombolysis. Both groups had similar safety outcomes including rates of symptomatic intracranial hemorrhage and 90-day mortality. CONCLUSIONS: Aspiration thrombectomy alone may result in higher rates of successful reperfusion and reduce the need for rescue devices compared with the combined approach with IV thrombolysis.

  PublisherDOI

• Antithrombotic Therapy for Noncardioembolic Ischemic Stroke: Current Evidence and Future Directions

  Stroke · 2026-03-13 · 1 citations

  article1st authorCorresponding

  Antithrombotic therapy plays an important role in reducing stroke recurrence. For noncardioembolic stroke, multiple trials have demonstrated the efficacy of antiplatelet monotherapy for secondary stroke prevention. In select situations, such as short-term treatment in the acute period after a minor stroke or transient ischemic attack, dual-antiplatelet therapy has demonstrated superiority to monotherapy. Multiple trials have tested more aggressive strategies using long-term combination antiplatelet medications or full-dose anticoagulation with limited evidence of a reduction in ischemic events but a relatively consistent increased risk of bleeding. Emerging new agents targeting factor XI/XIa may uncouple necessary hemostasis from pathological thrombosis and offer promise for enhancing secondary prevention of stroke without increasing bleeding. The recently positive OCEANIC-STROKE trial (Oral Factor Eleven A Inhibitor Asundexian as Novel Antithrombotic) testing dual-pathway inhibition with the factor XIa inhibitor asundexian in combination with antiplatelet therapy represents a major advance in antithrombotic therapy for noncardioembolic stroke. This review summarizes the current state of the evidence for antithrombotic therapy in secondary stroke prevention after noncardioembolic stroke and discusses completed and ongoing trials of novel factor XI/XIa inhibitors for stroke prevention.

  PublisherDOI

• Abstract WP251: Neuroimaging features of cerebral air embolism: a matched case-control study

  Stroke · 2026-01-29

  articleSenior author

  Introduction: Cerebral air embolism (CAE) is a rare but treatable cause of ischemic stroke. Prompt diagnosis is critical to expedite appropriate treatment. We aimed to better define the imaging features of CAE by comparing MRI features in patients with confirmed CAE to those in cardioembolic stroke due to atrial fibrillation (AF). Methods: In a retrospective, matched case-control study, CAE cases from 2012-2023 were matched 1:2 by presenting NIHSS to control patients who had stroke due to AF and were not treated with thrombolytics or thrombectomy. MRIs were reviewed by a neuroradiologist blinded to group. The primary outcome was presence of pre-specified neuroimaging features on MRI, which included number of infarctions, diffusion restriction pattern, location, and laterality. Results: Fourteen patients with stroke due to CAE (median age 61, 64% female, median NIHSS 12) and 28 controls with stroke due to AF (median age 81, 43% female, median NIHSS 12) were included. The predominant infarct topography in CAE patients was gyriform in 86%, punctate in 7%, and wedge-shaped in 7%, whereas in patients with stroke due to AF the predominant infarct topography was wedge-shaped in 71%, punctate in 18%, and gyriform in 11% (p&lt;0.001). CAE patients more often presented with multiple (93% versus 50%, p=0.007) and bilateral infarctions (79% versus 43%, p=0.048). Cortical borderzone involvement was more frequent in patients with CAE compared to those with AF (86% versus 25%, p&lt;0.001). There was no difference in vascular territory distribution of infarctions between groups. The presence of both predominantly gyriform infarction topography and cortical borderzone involvement had a 76.6% sensitivity and 96.4% specificity for CAE. Conclusions and Relevance: In this matched case-control study, we found that CAE cause characteristic gyriform infarction patterns on MRI that are distinct from typical cardioembolic stroke. In addition, cortical borderzone predilection and multifocal infarctions were substantially more frequent in CAE. This constellation of findings, in the appropriate clinical context, should strongly suggest CAE as the mechanism of neurologic injury, and may facilitate timely identification of this uncommon but critical diagnosis.

  PublisherDOI

• LB-002 Core lab and clinical outcome adjudicated results of M2 aspiration thrombectomy: a subgroup analysis from the imperative trial

  2025-07-01

  articleOpen access

  <h3>Introduction</h3> Recent trials (ESCAPE-MeVO and DISTAL) failed to demonstrated superiority of endovascular thrombectomy (EVT) for medium and small vessel occlusions compared to medical management (MM). Potential limitations of these trials include an older patient population, milder presenting National Institutes of Health Stroke Scale (NIHSS), a higher proportion of patients with premorbid disability, longer intervals from presentation to revascularization, inclusion of both medium and small vessel occlusions in the same study, and a very high percentage of patients being treated with stent retrievers (SRs). Here we present M2 occlusion data from the prospective Imperative Trial (IT) evaluating the Zoom System for aspiration thrombectomy. <h3>Methods</h3> The IT is a prospective, multicenter, single-arm core lab and independent safety board adjudicated trial evaluating the Zoom System (Imperative Care, Inc., Campell, California) for intracranial large vessel and M2 occlusion. In this sub-analysis, patients with core lab adjudicated M2 occlusions were identified and their data summarized for evaluation. Good and excellent angiographic outcomes were defined as final reperfusion mTICI≥2b and mTICI ≥2c, respectively. Good and excellent clinical outcome were defined as mRS 0-2 and 0-1 at 90 days, respectively. Safety was evaluated by all-cause mortality, symptomatic intracranial hemorrhage (sICH) and all hemorrhage. <h3>Results</h3> Of the 260 patients prospectively enrolled in the IT, 25% (65/260) presented with primary M2 occlusions and were included in this analysis. The median age was 69 (IQR 57.5-79.5) years with a median presenting NIHSS of 13 (IQR 10.3-17). Good and excellent reperfusion was 88% (57/65) and 66% (43/65), respectively. Good and excellent clinical outcomes at 90 days occurred in 62% (39/63) and 56% (35/63) of patients, respectively. All-cause mortality, sICH, and all hemorrhage were 4.6% (3/65), 1.5% (1/65), and 18.5% (12/65), respectively. These outcomes compared favorably with the EVT and MM arms of both ESCAPE-MeVO and Distal (table 1). <h3>Conclusions</h3> M2 occlusions in the IT presented with higher NIHSS in younger patients than observed in recent MeVO trials. Results demonstrated excellent angiographic, clinical, and safety outcomes when treated with the Zoom Reperfusion System. These data suggest that excellent safety and clinical outcomes can be achieved with aspiration thrombectomy, despite significant presenting deficits in an M2 occlusion population. Future randomized trials for medium vessel occlusions are warranted. <h3>Disclosures</h3> <b>J. Mascitelli:</b> 2; C; Stryker, Imperative Care. <b>R. De Leacy:</b> 2; C; Hyprevention, Imperative Care, J&amp;J, Medical Device Business Services, Scientia Vascular, Stryker. 4; C; Endostream, Q’Apel, Spartan Micro, Synchron, Van Vascular, Vastrax. <b>W. Mack:</b> 2; C; Egret, Imperative Care, Integra LifeSciences, Q’Apel, Rebound Therapeutics, Spartan Micro, Stream Biomedical, Stryker, Viseon. 4; C; Borvo, Cerebrotech, Egret, Endostream, Q’Apel, Radical Catheters, Rebound Therapeutics, Spartan Micro, Stream Biomedical, Vastrax, Viseon. <b>R. Nogueira:</b> 2; C; Stryker, Cerenovus, Medtronic, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Imperative Care. 4; C; Brainomix, Viz-AI, Corindus Vascular Robotics, Vesalio, Ceretrieve, Astrocyte, Cerebrotech. <b>S. Majidi:</b> 2; C; DePuy Synthes, Imperative Care, Medical Device Business Services, Rapid Medical. <b>D. Tomalty:</b> 2; C; Imperative Care. 3; C; Inari Medical. <b>M. Mokin:</b> 1; C; NIH. 2; C; Balt USA, Canon Medical, Imperative Care, J&amp;J, Medtronic, MicroVention, Rapid Pulse. 4; C; Bendit Technology, Borvo Medical, Brain Q, Endostream, QAS.AI, Quantanosis.AI, Radical Catheter Technologies, Serenity Medical, Sim&amp;Cure, Synchrone, VICIS. <b>J. Vargas:</b> 2; C; Viz.AI, Imperative Care, Precision Neuro, Q’Apel, Medtronic, Microvention. 4; C; Viz.AI, Imperative Care, Borvo, Radical, Synchron. <b>B. Cucchiara:</b> None. <b>K. Snyder:</b> 2; C; Boston Scientific, Canon Medical Systems, MicroVention, Medtronic, Stryker. 3; C; Canon Medical Systems USA Inc. 4; C; Boston Scientific, Access Closure, Niagara Gorge Medical. <b>V. Parada:</b> None. <b>H. Shakir:</b> 2; C; Imperative Care, Q’Apel Medical, Stryker, Terumo. 4; C; Borvo Medical, Cerebrotech, Radical Catheter Technologies, Sim&amp;Cure, Synchron. <b>D. Rosenbaum-Halevi:</b> None. <b>N. Aghaebrahim:</b> 3; C; Penumbra. <b>D. Hoit:</b> 2; C; Imperative Care, Stryker. 3; C; Medtronic, MicroVention. <b>B. Yim:</b> 2; C; Penumbra, Stryker, Terumo, Q’Apel, Imperative Care, Rapid Medical. <b>M. Tenser:</b> None. <b>A. Al-Bayati:</b> 2; C; Medical Device Business Services, Stryker. <b>J. Milburn:</b> 2; C; Imperative Care, MicroVention. <b>S. Nimjee:</b> 2; C; Medical Device Business Services, Baskin Biosciences. 3; C; Medtronic. <b>N. Haranhalli:</b> None. <b>M. Nahhas:</b> None. <b>D. Shaff:</b> None. <b>K. Layton:</b> 2; C; Stryker. <b>N. Beaty:</b> 2; C; Stryker. <b>R. Starke:</b> 3; C; Medtronic, Penumbra. <b>H. Hawk:</b> None. <b>D. Haussen:</b> 2; C; Chiesi USA, DePuy Synthes, Stryker. <b>A. Pabaney:</b> None. <b>C. Kellner:</b> 1; C; Cerenovus, Medtronic. 2; C; Integra LifeSciences. <b>J. Grossberg:</b> 1; C; Emory Medical Care Foundation, Emory Neurosurgery Catalyst, Georgia Research Alliance, National Institute of Neurological Disorders and Stroke, Uniformed Services University-Surgical Critical Care Initiative. 2; C; Cognition, Imperative Care, NTI, Route 92.

  PublisherOA PDFDOI

• Prevalence of High-Risk CTA-Based Carotid Plaque-RADS Subtypes in Patients With Embolic Stroke of Undetermined Source

  Stroke · 2025-01-24 · 18 citations

  articleOpen accessSenior author

  BACKGROUND: A modified computed tomography angiography (CTA)–based Carotid Plaque Reporting and Data System (Plaque-RADS) classification was applied to a cohort of patients with embolic stroke of undetermined source to test whether high-risk Plaque-RADS subtypes are more prevalent on the ipsilateral side of stroke. With the widespread use of CTA for stroke evaluation, a CTA-based Plaque-RADS would be valuable for generalizability. METHODS: A retrospective observational cross-sectional study was conducted at a single integrated health system comprised of 3 hospitals with a comprehensive stroke center between October 1, 2015, and April 1, 2017. Patients with unilateral anterior circulation stroke and &lt;50% carotid stenosis on CTA were retrospectively identified. Maximum plaque thickness and ulceration were assessed by a neuroradiologist blinded to the stroke side. A semiautomated segmentation software measured intraplaque hemorrhage volumes. Modified CTA-based Plaque-RADS classification was defined as (1) no plaque, (2) plaque thickness &lt;3 mm, (3) plaque thickness ≥3 mm or ulcerated, and (4) plaque with intraplaque hemorrhage &gt;50 mm 3 irrespective of plaque thickness. High-risk plaque subtypes (Plaque-RADS 3 and 4) were compared with low-risk subtypes (Plaque-RADS 1 and 2). RESULTS: Ninety-four patients (55% women; median age, 66 years) were included. CTA-based Plaque-RADS categories for plaques ipsilateral to the stroke side were as follows: (1) 14.9%, (2) 42.6%, (3) 41.5%, and (4) 1.1%. Carotid plaques contralateral to stroke side were Plaque-RADS: (1) 21.3%, (2) 46.8%, (3) 31.9%, and (4) 0%. When compared with the contralateral side, plaques ipsilateral to the stroke side were significantly associated with high-risk Plaque-RADS subtypes in a mixed-effects logistic model adjusting for age and sex (adjusted odds ratio, 2.10 [95% CI, 1.20–3.71]; P =0.01). CONCLUSIONS: Carotid plaque ipsilateral to the stroke side was significantly associated with CTA-based high-risk Plaque-RADS subtypes in an embolic stroke of undetermined source cohort. A CTA-based Plaque-RADS classification may be useful for identifying potentially causative carotid plaque phenotypes in patients with embolic stroke of undetermined source.

  PublisherOA PDFDOI

• Abstract WMP65: Machine-learning Approach To Classify Vulnerable Calcified Plaque In Embolic Stroke Of Undetermined Source

  Stroke · 2025-01-30

  article

  Introduction: Embolic stroke of undetermined source (ESUS) may be associated with nonstenotic carotid artery plaques. Noncalcified plaque components such as intraplaque hemorrhage (IPH) as well as perivascular adipose tissue (PVAT) are associated with increased stroke risk, but the role of plaque calcifications is unclear. We examine a machine-learning approach using eXtreme Gradient Boosting (XGBoost) to classify carotid plaques as vulnerable or stable using non-calcified plaque features and calcification morphology. Methods: Patients with neck CT angiography and unilateral anterior circulation ESUS with calcific carotid plaque were retrospectively analyzed. Derived by a combination of manual scoring by a neuroradiologist blinded to stroke side and semi-automated plaque composition segmentation software (Elucid), plaque-level features included plaque thickness, ulceration, composition volumes (IPH, lipid-rich necrotic core, matrix) and PVAT. Calcification-level features, segmented/scored manually with 3D Slicer, included spotty calcification (arc &lt;90 degrees, thickness &lt;3 mm), rim-sign (adventitial site, &gt;90 degrees arc, and 2 mm non-calcified plaque), volume, surface area, roundness, flatness and density. Plaques ipsilateral to stroke side were defined as vulnerable and stable if contralateral. XGBoost models were trained to classify plaques as vulnerable/stable using 1) plaque-level, 2) calcification-level and 3) combination of both features. Data were split into training (80%) and test (20%) sets with 5-fold cross-validation (CV) to ensure consistency. Performance was measured by ROC AUC and accuracy. Results: 71 patients were included [116 calcific carotid plaques; 60 ipsi-, 56 contralateral to stroke; 270 calcifications (146 ipsi-, 124 contralateral)]. 11 plaque-level and 16 calcification-level metrics were extracted. Plaque-level model achieved AUC 0.38 and accuracy 0.38. Calcification-level model achieved AUC 0.60 and accuracy 0.56. Combined model achieved AUC 0.97 and accuracy 0.93, with 5-fold CV score range 0.70-0.93 and mean 0.80. Five most important features for the Combined model were plaque ulceration, calcification surface area, ratio of PVAT to total plaque volume, plaque thickness and PVAT volume. Conclusions: XGBoost model trained with a combination of noncalcified plaque and calcification features can classify plaque as vulnerable with &gt; 90% accuracy, superior to models exclusively trained with plaque-level or calcification-level features.

  PublisherDOI

• Clinical outcomes and independently adjudicated results of M2 aspiration thrombectomy: a subgroup analysis from the Imperative Trial

  Journal of NeuroInterventional Surgery · 2025-09-04 · 2 citations

  articleOpen access

  BACKGROUND: The ESCAPE-MeVO (Endovascular Treatment to Improve Outcomes for Medium Vessel Occlusions) and DISTAL (Endovascular Therapy plus Best Medical Treatment vs Best Medical Treatment Alone for Medium Vessel Occlusion Stroke) trials failed to demonstrate the superiority of endovascular thrombectomy over best medical management for medium and small vessel occlusions. Potential limitations of these trials include older patient populations, lower presenting National Institutes of Health Stroke Scale (NIHSS) scores, higher rates of premorbid disability, delayed revascularization times, inclusion of both medium and small vessel occlusions, and widespread use of stent retrievers. Here we present M2 occlusion data from the Imperative Trial, evaluating aspiration thrombectomy with the Zoom System. METHODS: The Imperative Trial is a prospective, multicenter, single-arm trial with independent core lab and safety board adjudication, evaluating aspiration thrombectomy with the Zoom System (Imperative Care, Campbell, CA, USA) for large vessel, including M2, occlusions. This subanalysis includes patients with primary M2 occlusions. Angiographic outcomes were defined as modified Treatment in Cerebral Infarction (mTICI) score ≥2b (good) and ≥2c (excellent). Clinical outcomes were defined as modified Rankin Scale score (mRS) 0-2 (good) and 0-1 (excellent) at 90 days. Safety was assessed by all-cause mortality, symptomatic intracranial hemorrhage (sICH), and all hemorrhage. RESULTS: Of 260 enrolled patients, 25% (65/260) had primary M2 occlusions. Median age was 69 years; median NIHSS was 13. Good and excellent reperfusion were achieved in 88% (57/65) and 66% (43/65), respectively. At 90 days, good and excellent clinical outcomes occurred in 62% (39/63) and 56% (35/63), respectively. Mortality, sICH, and any hemorrhage were 4.6% (3/65), 1.5% (1/65), and 18% (12/65), respectively. CONCLUSIONS: The Zoom System demonstrated excellent safety and efficacy in M2 occlusions. These findings support aspiration thrombectomy for M2 occlusions as a viable treatment in well-selected patients.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01NS061572

  NIH · $1.4M · 2012

• NIH Grant P41RR002305

  NIH · $8.8M · 2015

Frequent coauthors

• Steven R. Messé

  Hospital of the University of Pennsylvania

  328 shared

• Scott E. Kasner

  Hospital of the University of Pennsylvania

  305 shared

• Michael T. Mullen

  Temple University

  109 shared

• Lauren Sansing

  Yale University

  103 shared

• Larry B. Goldstein

  103 shared

• David C. Anderson

  University of Calgary

  102 shared

• Rima M. Dafer

  Rush University Medical Center

  101 shared

• Michael Schneck

  101 shared

Labs

• Neurovascular Ultrasound LaboratoryPI