BackgroundEndovascular thrombectomy is the gold standard treatment for emergent proximal large vessel occlusion stroke. The safety and efficacy of thrombectomy in distal branch occlusion is not well understood. We aimed to evaluate the technical safety and feasibility of thrombectomy in distal vessel occlusion (DVO).MethodsWe performed a retrospective analysis of consecutive acute stroke patients with distal intracranial occlusion (defined as M3, A2 or P2 occlusion) who underwent thrombectomy within 24 hours from the time of last known well. The primary efficacy outcome was successful reperfusion (TICI≥2B). Secondary outcomes included successful recanalization with ≤3 passes. The safety outcome included the rate of subarachnoid hemorrhage (SAH), all intracranial hemorrhages (ICH) and symptomatic ICH (sICH).ResultsTotal of 72 patients with acute DVO treated with thrombectomy were identified. The median (IQR) age was 70 (20), 38% women, and 21% African-American. The site of occlusion included M3 (54%), P2 (28%), and A2 (18%) segments of middle, posterior and anterior cerebral arteries, respectively. Admission NIHSS score median (IQR) was 12 (11), and 90% of the patients had baseline mRS≤ 2. Thirty six percent of the patients had received intravenous thrombolytic therapy. Successful recanalization was achieved in 90% of the patients. Forty six percent of the procedures were performed under general anesthesia. Direct aspiration technique was used in 64% of the patients. The median number of passes was 2, with successful thrombectomy achieved with ≤3 passes in 83% of the patients. ICH was seen in 16% of the patients, including 3 SAH. However, only one patient (1.3%) had sICH. Among 48 patients in whom 90-day outcome data was available, 44% had favorable clinical outcome (mRS≤2).ConclusionThis single center, consecutive real-world experience demonstrates that thrombectomy in DVO stroke patients is safe and leads to high rate of successful recanalization. Further studies are warranted to evaluate the efficacy of thrombectomy in DVO in comparison to best medical management.Disclosures S. Majidi: None. S. Matsoukas: None. R. De Leacy: None. T. Oxley: None. H. Shoirah: None. T. Shigematsu: None. C. Kellner: None. J. Fifi: None. J. Mocco: None.