Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions

Imene Chafai; Hamza Salim; Basel Musmar; Nimer Adeeb; Vivek Yedavalli; Kareem Elnaamani; Nils Henninger; Simona Nedelcu; Sri Hari Sundararajan; Anna Luisa Kuehn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Benjamin Y. Q. Tan; Jeremy Josef Heit; Robert W. Regenhardt; Nicole M. Cancelliere; Joshua D. Bernstock; Aymeric Rouchaud; Jens Fiehler; Sunil A. Sheth; Muhammed Amir Essibayi; Ajit S. Puri; Christian Dyzmann; Marco Colasurdo; Gaultier Marnat; Leonardo Renieri; Joao Pedro Filipe; Pablo Harker; Razvan Alexandru Radu; Thomas R. Marotta; Julian Spears; Takahiro Ota; Ashkan Mowla; Pascal Jabbour; Arundhati Biswas; Frederic Clarencon; Thanh N. Nguyen; Ricardo Varela; Amanda Baker; David Altschul; Nestor Gonzalez; Markus A. Moehlenbruch; Costalat; Benjamin Gory; Paul Stracke; Mohammad A. Aziz-Sultan; Constantin Hecker; Hamza Shaikh; David S. Liebeskind; Alessandro Pedicelli; Andrea Maria Alexandre; Illario Tancredi; Tobias D. Faizy; Erwah Kalsoum; Aman B. Patel; Robert Fahed; Maud Wang; Vitor Mendes Pereira; Boris Lubicz; Adam A. Dmytriw; Adrien Guenego; MAD MT Investigators

doi:10.1177/15910199251342841

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Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions

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Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions

Imene Chafai, Hamza Salim, Basel Musmar, Nimer Adeeb, Vivek Yedavalli, Kareem Elnaamani, Nils Henninger, Simona Nedelcu, Sri Hari Sundararajan, Anna Luisa Kuehn, …

Interventional neuroradiology, p.15910199251342841

16/07/2025

DOI: https://doi.org/10.1177/15910199251342841

PMID: 40665742

Résumé

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

Radiology, Nuclear Medicine & Medical Imaging

Science & Technology

Objective Mechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still experience poor long-term clinical outcomes, prompting our study to comprehensively explore pre-MT factors influencing outcome despite excellent recanalization (final modified Thrombolysis in Cerebral Infarction [mTICI] score >= 2c). Methods We retrospectively examined data from patients who consecutively underwent MT for a primary middle cerebral artery (MCA) DMVO across 37 centers in North America, Asia, and Europe. We identified baseline clinical and imaging factors associated with poor clinical outcome (defined as a modified Rankin Scale [mRS] score of 3-6) at 3 months, despite excellent recanalization using a multivariable model. Results Between September 2017 and July 2021, 623 patients achieved mTICI > 2b and they were included in our study. Among them, 198 (32%) experienced a poor clinical outcome (mRS 3-6). Predictors of poor clinical outcome included higher age (OR 1.05 [1.03-1.07], p < 0.001), higher NIHSS at admission (OR 1.12 [1.08-1.15], p < 0.001), higher baseline mRS (OR 1.77 [0.96-3.26], p = 0.067), and diabetes (OR 1.59 [1.01-2.48], p = 0.044). Higher ASPECTS was associated with a decreased risk of poor clinical outcome (OR 0.82 [0.71-0.94], p = 0.006). Conclusion Older age, diabetes, higher baseline mRS, and NIHSS were associated with poor clinical outcome in MCA DMVO despite excellent recanalization. Conversely, a higher ASPECTS decreased the probability of such an outcome.

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Titre: Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions
Créateurs - sans rôle: Imene Chafai - Erasme Univ Hosp, Dept Intervent Neuroradiol, Brussels, Belgium
Hamza Salim - College Station Medical Center
Basel Musmar - Louisiana State University
Nimer Adeeb - Louisiana State University
Vivek Yedavalli - College Station Medical Center
Kareem Elnaamani - Thomas Jefferson Univ, Dept Neurosurg, Philadelphia, PA USA
Nils Henninger - Univ Massachusetts, Chan Med Sch, Dept Neurol, Worcester, MA USA
Simona Nedelcu - Univ Massachusetts, Chan Med Sch, Dept Neurol, Worcester, MA USA
Sri Hari Sundararajan - Rutgers Hlth New Jersey Med Sch NJMS, Dept Endovascular Neurosurg & Neuroradiol, Newark, NJ USA
Anna Luisa Kuehn - Univ Massachusetts, Med Ctr, Dept Radiol, Div Neurointervent Radiol, Worcester, MA USA
Jane Khalife - Rowan University
Sherief Ghozy - Mayo Clin, Rochester, MA USA
Luca Scarcia - Henri Mondor Hosp, Dept Neuroradiol, Creteil, France
Benjamin Y. Q. Tan - Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore
Jeremy Josef Heit - College Station Medical Center
Robert W. Regenhardt - Massachusetts Gen Hosp, Anodover, MA USA
Nicole M. Cancelliere - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada
Joshua D. Bernstock - Harvard Med Sch, Boston, MA USA
Aymeric Rouchaud - Univ Limoges, Univ Hosp Limoges, Neuroradiol Dept, Dupuytren,XLIM CNRS,UMR, Limoges, France
Jens Fiehler - Rowan Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA
Sunil A. Sheth - UTHealth, McGovern Med Sch, Dept Neurol, Houston, TX USA
Muhammed Amir Essibayi - Albert Einstein College of Medicine
Ajit S. Puri - College Station Medical Center
Christian Dyzmann - Lubeck GmbH, Neuroradiol Dept, Sana Kliniken, Lubeck, Germany
Marco Colasurdo - University of Portland
Gaultier Marnat - Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France
Leonardo Renieri - Osped Careggi Firenze, Interventist Neurovasc, Florence, Italy
Joao Pedro Filipe - Ctr Hosp Univ Porto, Dept Diagnost & Intervent Neuroradiol, Porto, Portugal
Pablo Harker - University of Cincinnati
Razvan Alexandru Radu - Montpellier Univ, Gui Chauliac Hosp, Dept Neuroradiol, Med Ctr, Montpellier, France
Thomas R. Marotta - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada
Julian Spears - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada
Takahiro Ota - Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Tokyo, Japan
Ashkan Mowla - Univ Southern Calif USC, Keck Sch Med, Dept Neurol Surg, Div Stroke & Endovascular Neurosurg, Los Angeles, CA USA
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - New York Medical College
Frederic Clarencon - Hop La Pitie Salpetriere, Dept Neuroradiol, Paris, France
Thanh N. Nguyen - Boston Med Ctr, Boston, MA USA
Ricardo Varela - Ctr Hosp Univ Porto, Dept Neurol, Porto, Portugal
Amanda Baker - Albert Einstein College of Medicine
David Altschul - Albert Einstein College of Medicine
Nestor Gonzalez - College Station Medical Center
Markus A. Moehlenbruch - Universitatsklinikum Heidelberg, Sekt Vaskulare & Intervent Neuroradiol, Heidelberg, Germany
Costalat - Montpellier Univ, Gui Chauliac Hosp, Dept Neuroradiol, Med Ctr, Montpellier, France
Benjamin Gory - Nancy Univ Hosp, Dept Intervent Neuroradiol, Nancy, France
Paul Stracke - Univ Med Ctr Munster, Dept Radiol, Intervent Neuroradiol Sect, Munster, Germany
Mohammad A. Aziz-Sultan - Harvard Med Sch, Boston, MA USA
Constantin Hecker - University of Salzburg
Hamza Shaikh - Rowan University
David S. Liebeskind - Univ Calif Los Angeles, Stroke Ctr, Los Angeles, CA USA
Alessandro Pedicelli - Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Rome, Italy
Andrea Maria Alexandre - Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Rome, Italy
Illario Tancredi - Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium
Tobias D. Faizy - Univ Med Ctr Munster, Dept Radiol, Neuroendovascular Program, Munster, Germany
Erwah Kalsoum - Univ Chicago, Dept Neurol, Chicago, IL USA
Aman B. Patel - Massachusetts Gen Hosp, Anodover, MA USA
Robert Fahed - Div Neurol, Dept Med, Ottawa, ON, Canada
Maud Wang - Erasme Univ Hosp, Dept Intervent Neuroradiol, Brussels, Belgium
Vitor Mendes Pereira - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada
Boris Lubicz - Erasme Univ Hosp, Dept Intervent Neuroradiol, Brussels, Belgium
Adam A. Dmytriw - Massachusetts Gen Hosp, Anodover, MA USA
Adrien Guenego - Erasme Univ Hosp, Dept Intervent Neuroradiol, Brussels, Belgium
MAD MT Investigators
Détails de publication: Interventional neuroradiology, p.15910199251342841
Éditeur: Sage
Nombre de pages: 10
Identifiants: 99163008109311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article