Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study

Hamza Adel Salim; Vivek Yedavalli; Basel Musmar; Nimer Adeeb; Muhammed Amir Essibayi; Kareem El Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kuehn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Benjamin Y. Q. Tan; Benjamin Pulli; Jeremy J. Heit; Robert W. Regenhardt; Nicole M. Cancelliere; Joshua D. Bernstock; Aymeric Rouchaud; Jens Fiehler; Sunil Sheth; Ajit S. Puri; Christian Dyzmann; Marco Colasurdo; Xavier Barreau; 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; James E. Siegler; Thanh N. Nguyen; Ricardo Varela; Amanda Baker; David Altschul; Nestor R. Gonzalez; Markus A. Moehlenbruch; Vincent Costalat; Benjamin Gory; Christian Paul Stracke; Mohammad Ali Aziz-Sultan; Constantin Hecker; Hamza Shaikh; David S. Liebeskind; Alessandro Pedicelli; Andrea M. Alexandre; Illario Tancredi; Tobias D. Faizy; Erwah Kalsoum; Boris Lubicz; Aman B. Patel; Vitor Mendes Pereira; Adrien Guenego; Adam A. Dmytriw; MAD MT Investigators

doi:10.5853/jos.2024.01389

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Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study

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Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study

Hamza Adel Salim, Vivek Yedavalli, Basel Musmar, Nimer Adeeb, Muhammed Amir Essibayi, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kuehn, Jane Khalife, …

Journal of stroke, Vol.26(3), pp.434-445

01/09/2024

DOI: https://doi.org/10.5853/jos.2024.01389

PMID: 39266014

Résumé

Cardiovascular System & Cardiology

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

Peripheral Vascular Disease

Science & Technology

Background and Purpose The management of acute ischemic stroke (AIS) due to distal medium vessel occlusion (DMVO) remains uncertain, particularly in comparing the effectiveness of intravenous thrombolysis (IVT) plus mechanical thrombectomy (MT) versus IVT alone. This study aimed to evaluate the safety and efficacy in DMVO patients treated with either MT-IVT or IVT alone. Methods This multinational study analyzed data from 37 centers across North America, Asia, and Europe. Patients with AIS due to DMVO were included, with data collected from September 2017 to July 2023. The primary outcome was functional independence, with secondary outcomes including mortality and safety measures such as types of intracerebral hemorrhage. Results The study involved 1,057 patients before matching, and 640 patients post-matching. Functional outcomes at 90 days showed no significant difference between groups in achieving good functional recovery (modified Rankin Scale 0-1 and 0-2), with adjusted odds ratios (OR) of 1.21 (95% confidence interval [CI] 0.81 to 1.79; P =0.35) and 1.00 (95% CI 0.66 to 1.51; P >0.99), respectively. Mortality rates at 90 days were similar between the two groups (OR 0.75, 95% CI 0.44 to 1.29; P =0.30). The incidence of symptomatic intracerebral hemorrhage was comparable, but any type of intracranial hemorrhage was significantly higher in the MT-IVT group (OR 0.43, 95% CI 0.29 to 0.63; P <0.001). Conclusion The results of this study indicate that while MT-IVT and IVT alone show similar functional and mortality outcomes in DMVO patients, MT-IVT presents a higher risk of hemorrhagic complications, thus MT-IVT may not routinely offer additional benefits over IVT alone for all DMVO stroke patients. Further prospective randomized trials are needed to identify patient subgroups most likely to benefit from MT-IVT treatment in DMVO.

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Titre: Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study
Créateurs - sans rôle: Hamza Adel Salim - College Station Medical Center
Vivek Yedavalli - College Station Medical Center
Basel Musmar - Louisiana State University
Nimer Adeeb - Louisiana State University
Muhammed Amir Essibayi
Kareem El Naamani - Thomas Jefferson University
Nils Henninger - Albert Einstein College of Medicine
Sri Hari Sundararajan - Dept Endovasc Neurosurg & Neuroradiol NJMS, 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, Dept Neurol Surg & Radiol, Rochester, MN USA
Luca Scarcia - Henri Mondor Hosp, Dept Neuroradiol, F-94000 Creteil, France
Benjamin Y. Q. Tan - Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore
Benjamin Pulli - Stanford Med Ctr, Dept Intervent Neuroradiol, Palo Alto, CA USA
Jeremy J. Heit - College Station Medical Center
Robert W. Regenhardt - Harvard University
Nicole M. Cancelliere - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol & Neurosurg, Toronto, ON, Canada
Joshua D. Bernstock - Harvard Med Sch, Dept Neurosurg, Brigham & Womens Hosp, Boston, MA USA
Aymeric Rouchaud - Univ Limoges, Univ Hosp Limoges, Neuroradiol Dept, Limoges, France
Jens Fiehler - Rowan Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA
Sunil Sheth - UTHlth McGovern Med Sch, Dept Neurol, Houston, TX USA
Ajit S. Puri - College Station Medical Center
Christian Dyzmann - Lubeck GmbH, Neuroradiol Dept, Sana Kliniken, Lubeck, Germany
Marco Colasurdo - University of Portland
Xavier Barreau - Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France
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, Dept Neuroradiol, Med Ctr, Montpellier, France
Thomas R. Marotta - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol & Neurosurg, Toronto, ON, Canada
Julian Spears - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol & Neurosurg, 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 - Sorbonne Univ, Pitie Salpetriere Univ Hosp, Dept Neuroradiol, Paris, France
James E. Siegler - Rowan University
Thanh N. Nguyen - Boston Med Ctr, Dept Neurol & Radiol, 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 R. Gonzalez
Markus A. Moehlenbruch - Univ Klinikum Heidelberg, Sekt Vaskulare & Intervent Neuroradiol, Heidelberg, Germany
Vincent Costalat
Benjamin Gory - Cedars Sinai Med Ctr, Dept Neurosurg, Los Angeles, CA USA
Christian Paul Stracke - Univ Med Ctr Munster, Dept Radiol, Intervent Neuroradiol Sect, Munster, Germany
Mohammad Ali Aziz-Sultan - Harvard Med Sch, Dept Neurosurg, Brigham & Womens Hosp, Boston, MA USA
Constantin Hecker - Paracelsus Med Univ, Dept Neurol & Neurosurg, Christian Doppler Clin, Salzburg, Austria
Hamza Shaikh - Rowan University
David S. Liebeskind - Univ Calif Los Angeles, UCLA Stroke Ctr, Dept Neurol, Los Angeles, CA 90095 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
Illario Tancredi - Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium
Tobias D. Faizy
Erwah Kalsoum - Henri Mondor Hosp, Dept Neuroradiol, F-94000 Creteil, France
Boris Lubicz - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Aman B. Patel
Vitor Mendes Pereira - St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol & Neurosurg, Toronto, ON, Canada
Adrien Guenego - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Adam A. Dmytriw - Harvard Univ, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA 02115 USA
MAD MT Investigators
Détails de publication: Journal of stroke, Vol.26(3), pp.434-445
Éditeur: Korean Stroke Soc
Nombre de pages: 16
Identifiants: 99163062009311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article