Endovascular therapy versus medical management in isolated anterior cerebral artery acute ischemic stroke: a multinational multicenter propensity score-weighted study

Hamza Adel Salim; Benjamin Pulli; Vivek Yedavalli; Fathi Milhem; Basel Musmar; Nimer Adeeb; Dhairya A. Lakhani; Muhammed Amir Essibayi; Jeremy Josef Heit; Tobias D. Faizy; Kareem El Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kuhn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Leonard L. L. Yeo; Benjamin Y. Q. Tan; Robert W. Regenhardt; Nicole M. Cancelliere; Aymeric Rouchaud; Jens Fiehler; Sunil A. Sheth; Ajit S. Puri; Christian Dyzmann; Marco Colasurdo; Leonardo Renieri; Joao Pedro Filipe; Pablo Harker; Razvan Alexandru Radu; Mohamad Abdalkader; Piers Klein; Thomas R. Marotta; Julian Spears; Takahiro Ota; Ashkan Mowla; Pascal Jabbour; Arundhati Biswas; Frederic Clarencon; James E. Siegler; Thanh N. Nguyen; Ricardo Varela; Amanda Baker; David Altschul; Nestor Gonzalez; Markus A. Moehlenbruch; Vincent Costalat; Benjamin Gory; Paul Stracke; Constantin Hecker; Gaultier Marnat; Hamza Shaikh; Christoph J. Griessenauer; David S. Liebeskind; Alessandro Pedicelli; Andrea Maria Alexandre; Illario Tancredi; Erwah Kalsoum; Boris Lubicz; Aman B. Patel; Vitor Mendes Pereira; Max Wintermark; Adrien Guenego; Adam A. Dmytriw; MAD MT Investigators

doi:10.1136/jnis-2024-022467

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Endovascular therapy versus medical management in isolated anterior cerebral artery acute ischemic stroke: a multinational multicenter propensity score-weighted study

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Endovascular therapy versus medical management in isolated anterior cerebral artery acute ischemic stroke: a multinational multicenter propensity score-weighted study

Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Fathi Milhem, Basel Musmar, Nimer Adeeb, Dhairya A. Lakhani, Muhammed Amir Essibayi, Jeremy Josef Heit, Tobias D. Faizy, …

Journal of neurointerventional surgery, Vol.17(E2), pp.e356-e364

01/05/2025

DOI: https://doi.org/10.1136/jnis-2024-022467

PMID: 38977305

Résumé

Life Sciences & Biomedicine

Neuroimaging

Neurosciences & Neurology

Science & Technology

Surgery

Background Isolated anterior cerebral artery occlusions (ACAo) in patients with acute ischemic stroke present significant challenges due to their rarity. The efficacy and safety of endovascular therapy (EVT) in comparison with best medical therapy (BMT) for ACAo remains unclear. This study aimed to assess the outcomes of these treatments.Methods This multinational, multicenter study analyzed data from the MAD-MT registry. Data were collected retrospectively from 37 sites across North America, Asia, and Europe. Inverse probability of treatment weighting (IPTW) was applied to balance confounding variables. The primary outcome was functional independence (modified Rankin Scale (mRS) scores of 0-2) at 90 days. Secondary outcomes included excellent outcomes (mRS 0-1), mortality at 90 days, and NIH Stroke Scale (NIHSS) score on day 1 post treatment.Results Of the 108 patients, 36 received BMT and 72 underwent EVT. The median age was 75 years, and 56% were male. At 90 days, 40% of patients achieved mRS 0-2, with no significant difference between EVT and BMT (38% vs 45%, p=0.46). Procedural success (mTICI 2b-3) was 91% in the EVT group, with a sICH rate of 2.9%. IPTW-adjusted analysis showed no significant difference between EVT and BMT for functional independence (OR 1.17, 95% CI 0.23 to 6.02, p=0.85), mortality (25% vs 21%, p=0.71) or day 1 NIHSS scores (Beta 2.2, 95% CI -0.51 to 4.8, p=0.11).Conclusions EVT showed high procedural success but did not significantly improve functional outcomes or mortality compared with BMT in patients with ACAo. Further randomized trials are needed to clarify EVT's role in ACAo.

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Titre: Endovascular therapy versus medical management in isolated anterior cerebral artery acute ischemic stroke: a multinational multicenter propensity score-weighted study
Créateurs - sans rôle: Hamza Adel Salim - College Station Medical Center
Benjamin Pulli - Stanford Med Ctr, Dept Intervent Neuroradiol, Palo Alto, CA USA
Vivek Yedavalli - College Station Medical Center
Fathi Milhem - Harvard Univ, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA 02115 USA
Basel Musmar - Thomas Jefferson University
Nimer Adeeb - Louisiana State University
Dhairya A. Lakhani - West Virginia Univ, Dept Radiol, Morgantown, WV USA
Muhammed Amir Essibayi - Albert Einstein College of Medicine
Jeremy Josef Heit - College Station Medical Center
Tobias D. Faizy - Univ Med Ctr Munster, Dept Radiol, Neuroendovasc Program, Munster, Germany
Kareem El Naamani - Thomas Jefferson University
Nils Henninger - Univ Massachusetts, Chan Med Sch, Dept Neurol, Worcester, MA USA
Sri Hari Sundararajan - NJMS, Dept Endovasc Neurosurg & Neuroradiol NJMS, Newark, NJ USA
Anna Luisa Kuhn - College Station Medical Center
Jane Khalife - Rowan University
Sherief Ghozy - Mayo Clin, Dept Neurol Surg, Rochester, MN USA
Luca Scarcia - Henri Mondor Hosp, Dept Neuroradiol, Creteil, France
Leonard L. L. Yeo - Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore
Benjamin Y. Q. Tan - Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore
Robert W. Regenhardt - Harvard University
Nicole M. Cancelliere - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada
Aymeric Rouchaud - Limoges Univ Hosp, Neuroradiol Dept, Limoges, France
Jens Fiehler - Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany
Sunil A. Sheth - St Michaels Hosp, Neurovasc Ctr, Div Neurosurg, Toronto, ON, Canada
Ajit S. Puri - College Station Medical Center
Christian Dyzmann - Limoges Univ Hosp, Neuroradiol Dept, Limoges, France
Marco Colasurdo - Oregon Hlth & Sci Univ, Dotter Dept Intervent Radiol, Portland, OR USA
Leonardo Renieri - OSPED CAREGGI FIRENZE, Interventist Neurovasc, FLORENCE, Italy
Joao Pedro Filipe - Ctr Hosp Univ Porto, Dept Cardiol, Porto, Portugal
Pablo Harker - University of Cincinnati
Razvan Alexandru Radu - Montpellier Univ, Gui de Chauliac Hosp, Dept Neuroradiol, Med Ctr, Montpellier, France
Mohamad Abdalkader - College Station Medical Center
Piers Klein - College Station Medical Center
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, Keck Sch Med USC, Dept Neurol Surg, Div Stroke & Endovasc Neurosurg, Los Angeles, CA 90033 USA
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - College Station Medical Center
Frederic Clarencon - Univ Southern Calif, Keck Sch Med USC, Dept Neurol Surg, Div Stroke & Endovasc Neurosurg, Los Angeles, CA 90033 USA
James E. Siegler - Rowan University
Thanh N. Nguyen - Boston Med Ctr, Dept Neurol, Boston, MA USA
Ricardo Varela - Ctr Hosp Univ Porto, Dept Cardiol, 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 - Univ Klinikum Heidelberg, Sekt Vaskulare & Intervent Neuroradiol, Heidelberg, Germany
Vincent Costalat - Montpellier Univ, Gui de Chauliac Hosp, Dept Neuroradiol, Med Ctr, Montpellier, France
Benjamin Gory - Inserm
Paul Stracke - Univ Med Ctr Munster, Dept Radiol, Neuroendovasc Div, Munster, Germany
Constantin Hecker - Paracelsus Med Univ, Dept Neurol, Christian Doppler Clin, Salzburg, Austria
Gaultier Marnat - Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France
Hamza Shaikh - Rowan University
Christoph J. Griessenauer - Paracelsus Med Univ, Dept Neurol, Christian Doppler Clin, Salzburg, Austria
David S. Liebeskind - UCLA, UCLA Stroke Ctr, Los Angeles, CA USA
Alessandro Pedicelli - Fdn Policlin Univ A Gemelli, IRCCS Roma, Rome, Italy
Andrea Maria Alexandre - Fdn Policlin Univ A Gemelli, IRCCS Roma, Rome, Italy
Illario Tancredi - Hop Civil Marie Curie, Neurol, Charleroi, Belgium
Erwah Kalsoum - Henri Mondor Hosp, Dept Neuroradiol, Creteil, France
Boris Lubicz - Erasme Univ Hosp, Dept Intervent Neuroradiol, B-1070 Brussels, Belgium
Aman B. Patel - Harvard University
Vitor Mendes Pereira - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada
Max Wintermark - MD Anderson Med Ctr, Dept Neuroradiol, Houston, TX 77030 USA
Adrien Guenego - Erasme Univ Hosp, Dept Intervent Neuroradiol, B-1070 Brussels, Belgium
Adam A. Dmytriw - Harvard Univ, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA 02115 USA
MAD MT Investigators
Détails de publication: Journal of neurointerventional surgery, Vol.17(E2), pp.e356-e364
Éditeur: Bmj Publishing Group
Nombre de pages: 9
Note de subvention: 5U54GM104942-08 / National Institute of General Medical Sciences of the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of General Medical Sciences (NIGMS)
Identifiants: 99163012609311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article