Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory

Tobias D Faizy; Vivek Yedavalli; Hamza Adel Salim; Dhairya A Lakhani; Basel Musmar; Nimer Adeeb; Muhammed Amir Essibayi; Motaz Daraghma; Kareem El Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kuhn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Leonard LL Yeo; Benjamin YQ Tan; Robert W Regenhardt; Jeremy Josef Heit; Nicole M Cancelliere; Aymeric Rouchaud; Jens Fiehler; Sunil A Sheth; Ajit S Puri; Christian Dyzmann; Marco Colasurdo; Leonardo Renieri; João Pedro Filipe; Pablo Harker; Răzvan Alexandru Radu; Mohamad Abdalkader; Piers Klein; Thomas R Marotta; Julian Spears; Takahiro Ota; Ashkan Mowla; Pascal Jabbour; Arundhati Biswas; Frédéric Clarençon; James E Siegler; Thanh N Nguyen; Ricardo Varela; Amanda Baker; David Altschul; Nestor Gonzalez; Markus A Möhlenbruch; Vincent Costalat; Benjamin Gory; Christian Paul Stracke; Constantin Hecker; Gaultier Marnat; Hamza Shaikh; Christoph J Griessenauer; David S Liebeskind; Alessandro Pedicelli; Andrea Maria Alexandre; Illario Tancredi; Erwah Kalsoum; Max Wintermark; Boris Lubicz; Aman B Patel; Vitor Mendes Pereira; Adam A Dmytriw; Adrien Guenego; Abdelaziz Amllay; Achala Vagal; Adrien ter Schiphorst; Ajith J. Thomas; Anil Gopinathan; Anne Dusart; Carolina Capirossi; Charbel Mounayer; Charlotte Weyland; Cheng-Yang Hsieh; Christopher J. Stapleton; Flavio Bellante; Géraud Forestier; H Hugo; Iacopo Valente; Igor Sibon PhD; James D. Rabinov; Jérôme Berge; Jessica Jesser; Juan Carlos Martinez-Gutierrez; Kevin Premat; Lina Chervak; Lukas Meyer; Mahmoud Elhorany; Miguel Quintero-Consuegra; Mohammad AliAziz-Sultan; Monika Killer-Oberpfalzer; T Peter; Kan Mph; Priyank Khandelwal; Ramanathan Kadirvel; Robert Fahed; Sergio Salazar-Marioni; Shogo Dofuku; Simona Nedelcu; Stavropoula I. Tjoumakaris; Suzana Saleme; Yasmin Aziz; Xavier Barreau; MAD-MT Investigators

doi:10.1136/jnis-2024-022642

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Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory

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Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory

Tobias D Faizy, Vivek Yedavalli, Hamza Adel Salim, Dhairya A Lakhani, Basel Musmar, Nimer Adeeb, Muhammed Amir Essibayi, Motaz Daraghma, Kareem El Naamani, Nils Henninger, …

Journal of neurointerventional surgery, Vol.18(1), pp.jnis-2024-022642-2024-022642

23/01/2025

DOI: https://doi.org/10.1136/jnis-2024-022642

PMID: 39855674

Résumé

Artery

Complication

Ischemic stroke

Stroke

Thrombectomy

Vessel Wall

BackgroundCurrent randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown.MethodsThis was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. Only patients with occlusion of the distal branches (M2 and M3) of the middle cerebral artery territory were included. Unsuccessful MT was defined as a modified Thrombolysis in Cerebral Infarction score of 0–2a. Propensity score matching was used to control for confounders. The primary outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days after treatment. Multivariable regression analysis was used to assess factors associated with the primary outcome.ResultsOf 2903 patients screened for eligibility, 532 patients were analyzed (266 per group) after propensity score matching. The MM group had superior functional outcomes, with 32% achieving mRS 0–1 at 90 days compared with 21% in the MT group (P=0.011). Patients in the MM group also had significantly lower rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 16%, P<0.001) and any hemorrhage (18% vs 48%, P<0.001). On multivariable regression, unsuccessful MT was associated with reduced odds of functional independence (OR 0.50, 95% CI 0.29 to 0.85, P=0.011) and increased odds of sICH (OR 4.32, 95% CI 1.84 to 10.10, P<0.001). Mortality rates were similar between groups (27% in MM vs 29% in MT, P=0.73).ConclusionUnsuccessful MT for MeVO was linked to worse outcomes than best MM. These findings highlight the risks of prolonged attempts and emphasize the importance of efficient procedural decision-making to reduce complications and improve patient outcomes.

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Titre: Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory
Créateurs - sans rôle: Tobias D Faizy - Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany
Vivek Yedavalli - Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
Hamza Adel Salim - Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA
Dhairya A Lakhani - Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
Basel Musmar - Thomas Jefferson University
Nimer Adeeb - Louisiana State University
Muhammed Amir Essibayi - University of Massachusetts Chan Medical School
Motaz Daraghma - Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Kareem El Naamani - Thomas Jefferson University
Nils Henninger - University of Massachusetts Chan Medical School
Sri Hari Sundararajan - Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA
Anna Luisa Kuhn - Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
Jane Khalife - Cooper University Hospital
Sherief Ghozy - Neurological Surgery
Luca Scarcia - Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
Leonard LL Yeo - Department of Medicine,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Benjamin YQ Tan - Division of Neurology, Department of Medicine, National University Hospital, Singapore
Robert W Regenhardt - Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada
Jeremy Josef Heit - Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA
Nicole M Cancelliere - Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
Aymeric Rouchaud - University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, France
Jens Fiehler - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Sunil A Sheth - The University of Texas Health Science Center at Houston
Ajit S Puri - Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
Christian Dyzmann - Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany
Marco Colasurdo - University of Portland
Leonardo Renieri - Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
João Pedro Filipe - Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
Pablo Harker - University of Cincinnati Medical Center
Răzvan Alexandru Radu - Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
Mohamad Abdalkader - Boston Medical Center
Piers Klein - Boston Medical Center
Thomas R Marotta - University of Toronto
Julian Spears - Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada
Takahiro Ota - Tokyo Metropolitan Tama Medical Center
Ashkan Mowla - Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), 1200 North State St, Suite 3300, Los Angeles, CA
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - Westchester Medical Center
Frédéric Clarençon - Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
James E Siegler - Cooper University Hospital
Thanh N Nguyen - Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
Ricardo Varela - Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
Amanda Baker - Albert Einstein College of Medicine
David Altschul - Albert Einstein College of Medicine
Nestor Gonzalez - Cedars-Sinai Medical Center
Markus A Möhlenbruch - Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
Vincent Costalat - Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
Benjamin Gory - Centre Hospitalier Régional et Universitaire de Nancy
Christian Paul Stracke - Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany
Constantin Hecker - Paracelsus Medical University
Gaultier Marnat - Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
Hamza Shaikh - Cooper University Hospital
Christoph J Griessenauer - Paracelsus Medical University
David S Liebeskind - UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA
Alessandro Pedicelli - UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Metropolitan, Italy
Andrea Maria Alexandre - UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Metropolitan, Italy
Illario Tancredi - Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
Erwah Kalsoum - Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
Max Wintermark - Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA
Boris Lubicz - Universitair Ziekenhuis Brussel
Aman B Patel - Brigham and Women's Hospital
Vitor Mendes Pereira - University of Toronto
Adam A Dmytriw - Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Adrien Guenego - Universitair Ziekenhuis Brussel
Abdelaziz Amllay
Achala Vagal
Adrien ter Schiphorst
Ajith J. Thomas
Anil Gopinathan
Anne Dusart
Carolina Capirossi
Charbel Mounayer
Charlotte Weyland
Cheng-Yang Hsieh
Christopher J. Stapleton
Erwah Kalsoum
Flavio Bellante
Géraud Forestier
Hamza Shaikh
H Hugo
Iacopo Valente
Igor Sibon PhD
James D. Rabinov
Jérôme Berge
Jessica Jesser
Juan Carlos Martinez-Gutierrez
Kevin Premat
Lina Chervak
Lukas Meyer
Mahmoud Elhorany
Miguel Quintero-Consuegra
Mohammad AliAziz-Sultan
Monika Killer-Oberpfalzer
T Peter
Kan Mph
Priyank Khandelwal
Ramanathan Kadirvel
Robert Fahed
Sergio Salazar-Marioni
Shogo Dofuku
Simona Nedelcu
Stavropoula I. Tjoumakaris
Suzana Saleme
Yasmin Aziz
Xavier Barreau
MAD-MT Investigators
Détails de publication: Journal of neurointerventional surgery, Vol.18(1), pp.jnis-2024-022642-2024-022642
Éditeur: BMJ Publishing Group Ltd
Note de subvention: 5U54GM104942-08 / National Institute of General Medical Sciences (http://dx.doi.org/10.13039/100000057)
Identifiants: 99162983109311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article