Intravenous Thrombolysis in Distal Medium Middle Cerebral Artery Occlusion Patients with Unsuccessful Mechanical Reperfusion

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

doi:10.1007/s00062-025-01583-8

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Intravenous Thrombolysis in Distal Medium Middle Cerebral Artery Occlusion Patients with Unsuccessful Mechanical Reperfusion

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Intravenous Thrombolysis in Distal Medium Middle Cerebral Artery Occlusion Patients with Unsuccessful Mechanical Reperfusion

Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Dhairya Lakhani, Orabi Hajjeh, Basel Musmar, Nimer Adeeb, Fathi Milhem, Davide Simonato, Yan-Lin Li, …

Clinical neuroradiology (Munich)

25/11/2025

DOI: https://doi.org/10.1007/s00062-025-01583-8

PMID: 41291271

Résumé

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

Radiology, Nuclear Medicine & Medical Imaging

Science & Technology

BackgroundThe efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) for distal, medium vessel occlusions (DMVO) is not well established. This study investigates whether IVT impacts outcomes in DMVO patients, particularly in those with unsuccessful or partial recanalization after MT.MethodsWe conducted a retrospective, multicenter study using data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. The study population included AIS patients with DMVO in the M2, M3, and M4 segments of the MCA, treated with or without IVT followed by MT and a final modified Thrombolysis in Cerebral Infarction (mTICI) score of 0, 1, or 2a. The primary outcome was functional independence, assessed by the 90-day modified Rankin Scale (mRS) of 0-1 or 0-2.ResultsThe study comprised 210 patients with final mTICI 0 to 2a, with 130 undergoing MT alone and 80 receiving IVT followed by MT. Logistic regression analysis revealed no significant differences in clinical outcomes between groups. The odds ratios (ORs) for achieving a 90-day mRS of 0-1 and 0-2 were 1.55 (95% CI 0.62 to 3.87; p = 0.34) and 1.55 (95% CI 0.72 to 3.37; p = 0.26), respectively. The odds of symptomatic intracerebral hemorrhage (sICH) were similar between groups (OR 0.64, 95% CI 0.28 to 1.47; p = 0.29), as were the odds of intracranial hemorrhage (ICH) of any type (OR 1.39, 95% CI 0.71 to 2.73; p = 0.34).ConclusionsIn AIS patients with DMVO and unsuccessful or partial recanalization after MT, IVT did not significantly improve clinical outcomes. Additionally, IVT did not increase the risk of hemorrhagic complications. These findings suggest that while IVT preceding MT is safe in this context, it may not improve outcomes for patients with unsuccessful MT.

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Titre: Intravenous Thrombolysis in Distal Medium Middle Cerebral Artery Occlusion Patients with Unsuccessful Mechanical Reperfusion
Créateurs - sans rôle: Hamza Adel Salim - College Station Medical Center
Benjamin Pulli - Stanford Med Ctr, Dept Intervent Neuroradiol, Stanford, CA USA
Vivek Yedavalli - College Station Medical Center
Dhairya Lakhani - Johns Hopkins Med Ctr, Dept Radiol, Div Neuroradiol, Baltimore, MD 21224 USA
Orabi Hajjeh - Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA
Basel Musmar - Thomas Jefferson University
Nimer Adeeb - Louisiana State University
Fathi Milhem - Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA
Davide Simonato - Univ Oxford, Oxford Univ Hosp NHS Fdn Trust, Dept Neuroradiol, Nuffield Dept Clin Neurosci, Oxford, England
Yan-Lin Li - Univ Oxford, Oxford Univ Hosp NHS Fdn Trust, Dept Neuroradiol, Nuffield Dept Clin Neurosci, Oxford, England
Muhammed Amir Essibayi - Albert Einstein College of Medicine
Nils Henninger - Univ Massachusetts, Dept Neurol, Chan Med Sch, Worcester, MA USA
Sri Hari Sundararajan - NJMS, Dept Endovascular Neurosurg & Neuroradiol, Newark, NJ USA
Anna Luisa Kuhn - College Station Medical Center
Jane Khalife - Rowen Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA
Sherief Ghozy - Univ Oxford, Nuffield Dept Primary Care Hlth Sci, Oxford, England
Luca Scarcia - Henri Mondor Hosp, Dept Neuroradiol, Creteil, France
Leonard 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 Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA
Aymeric Rouchaud
Jens Fiehler - Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany
Sunil Sheth - UTHlth, McGovern Med Sch, Dept Neurol, Houston, TX USA
Ajit S. Puri - College Station Medical Center
Christian Dyzmann - Lubeck GmbH, Sana Kliniken, Neuroradiol Dept, Lubeck, Germany
Marco Colasurdo - University of Portland
Leonardo Renieri - Osped Careggi Firenze, Interventist Neurovascolare, 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, Med Ctr, Dept Neuroradiol, Montpellier, France
Mohamad Abdalkader - College Station Medical Center
Piers Klein - College Station Medical Center
Takahiro Ota - Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Tokyo, Japan
Ashkan Mowla - Univ Southern Calif USC, Keck Sch Med, Dept Neurol Surg,Keck Sch Med, Div Stroke & Endovasc Neurosurg, North State St, Suite 3300, 1200, Los Angeles, CA USA
Kareem El Naamani - Thomas Jefferson University
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - New York Medical College
Frederic Clarencon - Sorbonne Univ, Pitie Salpetriere Hosp, Dept Neuroradiol, GRC BioFast, Paris, France
James E. Siegler - Rowen Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA
Thanh N. Nguyen - Boston Med Ctr, Dept Radiol, 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 R. Gonzalez - College Station Medical Center
Markus A. Mohlenbruch - Univ Klinikum Heidelberg, Sekt Vaskulare & Interventionelle Neuroradiol, Heidelberg, Germany
Vincent Costalat - Montpellier Univ, Gui Chauliac Hosp, Med Ctr, Dept Neuroradiol, Montpellier, France
Benjamin Gory - Nancy Univ Hosp, Dept Intervent Neuroradiol, Nancy, France
Christian Paul Stracke - Univ Med Ctr Munster, Dept Radiol, Intervent Neuroradiol Sect, Munster, Germany
Constantin Hecker - University of Salzburg
Gaultier Marnat - Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France
Hamza Shaikh - Rowen Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA
Christoph J. Griessenauer - University of Salzburg
David S. Liebeskind - UCLA, Stroke Ctr, Los Angeles, CA USA
Alessandro Pedicelli - Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Rome, Italy
Andrea M. Alexandre - Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Rome, Italy
Tobias D. Faizy - Univ Med Ctr Munster, Dept Radiol, Neuroendovascular Program, Munster, Germany
Illario Tancredi - Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium
Erwah Kalsoum - Henri Mondor Hosp, Dept Neuroradiol, Creteil, France
Boris Lubicz - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Vitor Mendes Pereira - University of Toronto
Aman B. Patel - Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA
Maurizio Fuschi - Univ Oxford, Oxford Univ Hosp NHS Fdn Trust, Dept Neuroradiol, Nuffield Dept Clin Neurosci, Oxford, England
Max Wintermark - MD Anderson Med Ctr, Dept Neuroradiol, Houston, TX 77030 USA
Jeremy J. Heit - College Station Medical Center
Adrien Guenego - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Adam A. Dmytriw - Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA
MAD MT Investigators
Détails de publication: Clinical neuroradiology (Munich)
Éditeur: Springer Nature
Nombre de pages: 13
Identifiants: 99163063909311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article