{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:41:28Z","timestamp":1791650488327,"version":"4.3.4"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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 analyzed the relationship between procedural approaches, petechial hemorrhage (PetH), and clinical outcomes in DMVO thrombectomy, with particular attention to technical considerations and the complex interplay between tissue injury and hemorrhagic complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>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 (modified Rankin Scale score \u2264 2) at 90 days, early neurological improvement (\u2265 4-point National Institutes of Health Stroke Scale score decrease at 24 hours), all-cause mortality, and independent determinants of PetH. Adjusted odds ratios (aORs), 95% confidence intervals, and p values were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 1428 patients, 439 (30.7%) developed PetH. Factors independently associated with PetH were multiple thrombectomy passes (aOR 1.58, 95% CI 1.21\u20132.06; p = 0.001), IV thrombolysis (aOR 1.31, 95% CI 1.01\u20131.69; p = 0.04), and the combined use of a stent retriever with aspiration as the first-line method compared with aspiration alone (aOR 1.66, 95% CI 1.15\u20132.38; p = 0.007). Conversely, general anesthesia (aOR 0.55, 95% CI 0.40\u20130.77; p &lt; 0.001), higher Alberta Stroke Program Early CT Scores (aOR 0.76, 95% CI 0.69\u20130.83; p &lt; 0.001), and successful recanalization (aOR 0.56, 95% CI 0.39\u20130.80; p = 0.002) were significantly associated with a lower odds of PetH. PetH was associated with a decreased odds of favorable functional outcomes (aOR 0.51, 95% CI 0.36\u20130.73; p &lt; 0.001), reduced early neurological improvement (aOR 0.59, 95% CI 0.44\u20130.79; p &lt; 0.001), and increased all-cause mortality (aOR 1.84, 95% CI 1.23\u20132.76; p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>PetH is a frequent sequela following MT in DMVO strokes and is associated with poorer outcomes, likely reflecting underlying ischemic injury rather than direct causation. Procedural factors influence PetH risk, suggesting medical treatment as first-line therapy for DMVOs, with MT reserved for refractory cases using less aggressive approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.jns243030","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T21:33:42Z","timestamp":1751664822000},"page":"1501-1513","source":"Crossref","is-referenced-by-count":7,"title":["Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes"],"prefix":"10.3171","volume":"143","author":[{"given":"Muhammed Amir","family":"Essibayi","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza Adel","family":"Salim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland;"},{"name":"Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa J.","family":"Fazzari","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;"},{"name":"Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basel","family":"Musmar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimer","family":"Adeeb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, New Orleans, Louisiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Henninger","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Massachusetts Chan Medical School, Worcester, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri Hari","family":"Sundararajan","sequence":"additional","affiliation":[{"name":"Department of Endovascular Neurosurgery and Neuroradiology, New Jersey Medical School, Newark, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Luisa","family":"K\u00fchn","sequence":"additional","affiliation":[{"name":"Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Khalife","sequence":"additional","affiliation":[{"name":"Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherief","family":"Ghozy","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Scarcia","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Henri Mondor Hospital, Cr\u00e9teil, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard L. 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