The 1st International Distal Thrombectomy Summit took place in North Italy, 14–15 June, 2019. According to a press release, the purpose of the meeting was to create a discussion about distal occlusions and explore questions that come to mind. For example, what should we call these occlusions? Middle or distal vessel occlusions? Which of them do have a neurological impact and which do not? How can we find them? What kind of imaging tools would we need? What kind of tools can we use for them? Which kind of clinical evidence is needed in order to know that we are helping patients?
Over 30 physicians from over 10 countries have participated in this meeting. The meeting focused on three aspects of the distal occlusion.
The first session was led by Jeff Saver, University of California, Los Angeles (UCLA), USA, and discussed the topic “WHY to Treat: Neurological Aspects of Distal Occlusions”. Thus, the anatomy of the anterior, middle and posterior cerebral arteries was discussed as well as the common location of perforators and some discussion of the territories of supply. Additionally, ischaemic stroke due to spontaneous (non-procedure-related) medium-size vessel occlusions: epidemiology, clinical features, and outcome was discussed, as well as emboli in new territories (ENT) and emboli in distal territories (EDT) complicating endovascular therapy. Lastly, the design of clinical trials for ischaemic stroke due to middle vessel occlusions was discussed.
The second session was led by Rishi Gupta, WellStar, Atlanta, USA and detailed the topic: “WHAT to Treat: Images Aspects of Distal Occlusions”, which predominantly focussed on the value in creating a database of distal occlusions. Moreover, imaging aspects of both primary and secondary medium vessel occlusions were outlined.
Lastly, the third session was led by Professor Rene Chapot, Alfried Krupp Krankenhaus, Essen, Germany, who introduced the topic: “HOW to Treat: Interventional Aspects of Distal Occlusions”. The following topics were discussed: posterior cerebral artery (PCA) occlusions—USA experience, tPA treatment in small/medium vessel occlusions, aspiration treatment in small/medium vessel occlusions and tigertriever 13 treatment in small/medium vessel occlusions.
According to the news release, the conclusion following these discussions suggested that, “we have a long way to go. We need to define best indications for distal thrombectomy, invest in registries and studies to prove it is achievable. However, distal mechanical thrombectomy will still compete with IV lysis”.
It was decided to create a working group and hold the 2nd International Distal Thrombectomy Summit in New York in May, 2020.