Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study

Hamza Adel Salim; Vivek Yedavalli; Basel Musmar; Nimer Adeeb; Kareem E L Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kühn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Benjamin Yong Qiang Tan; Jeremy J Heit; Robert W Regenhardt; Nicole M Cancelliere; Joshua D Bernstock; Aymeric Rouchaud; Jens Fiehler; Muhammed Amir Essibayi; Sunil A Sheth; Ajit S Puri; Xavier Barreau; Marco Colasurdo; Leonardo Renieri; Christian Dyzmann; Thomas Marotta; Julian Spears; Askan Mowla; Pascal Jabbour; João Pedro Filipe; Arundhati Biswas; Pablo Harker; Frédéric Clarençon; Răzvan Alexandru Radu; James E Siegler; Thanh N Nguyen; Ricardo Varela; Takahiro Ota; Nestor Gonzalez; Markus A Moehlenbruch; David Altschul; Benjamin Gory; Vincent Costalat; Christian Paul Stracke; Mohammad Ali Aziz-Sultan; Constantin Hecker; Hamza Shaikh; David S Liebeskind; Amanda Baker; Alessandro Pedicelli; Andrea Alexandre; Tobias D Faizy; Illario Tancredi; Erwah Kalsoum; Boris Lubicz; Aman B Patel; Vitor Mendes Pereira; Adrien Guenego; Adam A Dmytriw; MAD MT Investigators

doi:10.1136/jnnp-2024-333669

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Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study

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Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study

Hamza Adel Salim, Vivek Yedavalli, Basel Musmar, Nimer Adeeb, Kareem E L Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, …

Journal of neurology, neurosurgery and psychiatry, Vol.96(3), pp.239-248

23/07/2024

DOI: https://doi.org/10.1136/jnnp-2024-333669

PMID: 39043567

Résumé

Aged

Aged, 80 and over

Endovascular Procedures - adverse effects

Endovascular Procedures - methods

Female

Humans

Infarction, Middle Cerebral Artery - therapy

Ischemic Stroke - drug therapy

Ischemic Stroke - surgery

Ischemic Stroke - therapy

Male

Middle Aged

Propensity Score

Retrospective Studies

Thrombectomy

Treatment Outcome

The efficacy of endovascular treatment (EVT) in acute ischaemic stroke due to distal medium vessel occlusion (DMVO) remains uncertain. Our study aimed to evaluate the safety and efficacy of EVT compared with the best medical management (BMM) in DMVO. In this prospectively collected, retrospectively reviewed, multicentre cohort study, we analysed data from the Multicentre Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy registry. Patients with acute ischaemic stroke due to DMVO in the M2, M3 and M4 segments who underwent EVT or received BMM were included. Primary outcome measures comprised 10 co-primary endpoints, including functional independence (mRS 0-2), excellent outcome (mRS 0-1), mortality (mRS 6) and haemorrhagic complications. Propensity score matching was employed to balance the cohorts. Among 2125 patients included in the primary analysis, 1713 received EVT and 412 received BMM. After propensity score matching, each group comprised 391 patients. At 90 days, no significant difference was observed in achieving mRS 0-2 between EVT and BMM (adjusted OR 1.00, 95% CI 0.67 to 1.50, p>0.99). However, EVT was associated with higher rates of symptomatic intracerebral haemorrhage (8.4% vs 3.0%, adjusted OR 3.56, 95% CI 1.69 to 7.48, p<0.001) and any intracranial haemorrhage (37% vs 19%, adjusted OR 2.61, 95% CI 1.81 to 3.78, p<0.001). Mortality rates were similar between groups (13% in both, adjusted OR 1.48, 95% CI 0.87 to 2.51, p=0.15). Our findings suggest that while EVT does not significantly improve functional outcomes compared with BMM in DMVO, it is associated with higher risks of haemorrhagic complications. These results support a cautious approach to the use of EVT in DMVO and highlight the need for further prospective randomised trials to refine treatment strategies.

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Détails

Titre: Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study
Créateurs - sans rôle: Hamza Adel Salim - Louisiana State University Health Sciences Center Shreveport
Vivek Yedavalli - Johns Hopkins Medicine
Basel Musmar - Louisiana State University Health Sciences Center Shreveport
Nimer Adeeb - Neurosurgery, BIDMC, Shreveport, Louisiana, USA
Kareem E L Naamani - Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Nils Henninger - University of Massachusetts Chan Medical School
Sri Hari Sundararajan - New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
Anna Luisa Kühn - Mass General Brigham
Jane Khalife - Cooper Hospital University Medical Center, Camden, New Jersey, USA
Sherief Ghozy - Mayo Clinic
Luca Scarcia - Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
Benjamin Yong Qiang Tan - Internal Medicine, NUHS, Singapore
Jeremy J Heit - Stanford Medicine
Robert W Regenhardt - Harvard Medical School
Nicole M Cancelliere - Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
Joshua D Bernstock - Brigham and Women's Hospital
Aymeric Rouchaud - Radiology, Mayo Clinic, Rochester, Minnesota, USA
Jens Fiehler - Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Muhammed Amir Essibayi - Montefiore Medical Center
Sunil A Sheth - Neurology, University of Texas - Houston, Houston, Texas, USA
Ajit S Puri - Radiology and Neurosurgery, Univ Massachusetts, Worcester, Massachusetts, USA
Xavier Barreau - Centre Hospitalier Universitaire de Bordeaux
Marco Colasurdo - Oregon Health & Science University
Leonardo Renieri - Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
Christian Dyzmann - Sana Kliniken AG, Ismaning, Bayern, Germany
Thomas Marotta - University of Toronto
Julian Spears - Department of Surgery, Division of Neurosurgery, University of Toronto, Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
Askan Mowla - USC Keck School of Medicine, Los Angeles, California, USA
Pascal Jabbour - Thomas Jefferson University
João Pedro Filipe - Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
Arundhati Biswas - Albert Einstein College of Medicine
Pablo Harker - University of Cincinnati
Frédéric Clarençon - Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
Răzvan Alexandru Radu - Hospital Gui de Chauliac Head and Neck Neuroscience Unit, Montpellier, France
James E Siegler - Hospital of the University of Pennsylvania
Thanh N Nguyen - Neurology, Neurosurgery, Radiology, Boston University Medical Center, Boston, Massachusetts, USA
Ricardo Varela - Neurology, University of California, Los Angeles, Los Angeles, California, USA
Takahiro Ota - Radiological Sciences, Catholic University of Sacred Heart, "A. Gemelli" Hospital, Rome, Italy
Nestor Gonzalez - Radiology and Neuroradiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Markus A Moehlenbruch - University of Münster, Munster, Germany
David Altschul - Montefiore Medical Center
Benjamin Gory - Hôpital Civil Marie Curie à Lodelinsart, Charleroi, Belgium
Vincent Costalat - Neuroradiology, Henri Mondor Hospital, Créteil, France
Christian Paul Stracke - Centre Universitair Bruxelles Hôpital Erasme, Bruxelles, Belgium
Mohammad Ali Aziz-Sultan - Brigham and Women's Hospital, Boston, Massachusetts, USA
Constantin Hecker - Paracelsus Medical University
Hamza Shaikh - Interventional Neuroradiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
David S Liebeskind - Neurology, University of California, Los Angeles, Los Angeles, California, USA
Amanda Baker - Montefiore Medical Center
Alessandro Pedicelli - Università Cattolica del Sacro Cuore
Andrea Alexandre - Radiology and Neuroradiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Tobias D Faizy - University of Münster
Illario Tancredi - Hôpital Civil Marie Curie à Lodelinsart, Charleroi, Belgium
Erwah Kalsoum - Neuroradiology, Henri Mondor Hospital, Créteil, France
Boris Lubicz - Centre Universitair Bruxelles Hôpital Erasme, Bruxelles, Belgium
Aman B Patel - Massachusetts General Hospital
Vitor Mendes Pereira - Toronto Western Hospital
Adrien Guenego - Interventional Neuroradiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Adam A Dmytriw - University of Toronto
MAD MT Investigators
Détails de publication: Journal of neurology, neurosurgery and psychiatry, Vol.96(3), pp.239-248
Identifiants: 99163071809311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article