The goal of this clinical trial is to determine whether rescue distal mechanical thrombectomy can improve outcomes in patients with persistent distal occlusions after successful proximal mechanical thrombectomy for acute ischemic stroke.
Many patients with acute ischemic stroke caused by large vessel occlusion undergo emergency treatment with proximal mechanical thrombectomy, which removes the main clot and restores flow in a large artery. However, in some patients, one or more smaller distal arteries remain occluded after successful proximal recanalization. It is not yet known whether treating these persistent distal occlusions improves angiographic or clinical outcomes.
This study will compare two approaches:
Rescue distal mechanical thrombectomy: an additional distal mechanical thrombectomy procedure is performed during the same endovascular session.
Conservative management: no additional distal endovascular intervention is performed after successful proximal mechanical thrombectomy.
The main questions the study aims to answer are:
* Is rescue distal mechanical thrombectomy feasible in this setting? * Is it safe? * Does it improve angiographic and clinical outcomes?
Participants will be randomly assigned during the index endovascular procedure to one of the two study groups and will be followed with imaging and clinical assessments during hospitalization and at 90 days.
Approximately 72 participants will take part in this study at the Centre hospitalier de l'Université de Montréal (CHUM).
Age ≥ 18 years
Acute ischemic stroke with proximal large vessel occlusion (M1, M2, ICA, or basilar artery) treatable with mechanical thrombectomy
Presence of one or more persistent distal occlusions (M2-M4, A1-A5, or P1-P5) after successful proximal mechanical thrombectomy
The participant is considered suitable for either rescue distal mechanical thrombectomy or conservative management in the event of persistent distal occlusion
Poor expected 3-month prognosis due to comorbid conditions
Opposition by the participant or, in emergency inclusion circumstances, by an authorized representative