Mechanical thrombectomy for minor and mild stroke patients harboring large vessel occlusion in the anterior circulation: A multicenter case control study

Cyril Dargazanli; Caroline Arquizan; Arturo Consoli; Benjamin Gory; Omer Eker; Xavier Ayrignac; Jean-Pierre Decroix; Astrid Corlobé; Isabelle Mourand; Grégory Gascou; Mahmoud Charif; Julien Labreuche; Alain Duhamel; Paul-Emile Labeyrie; Hocine Redjem; Gabriele Ciccio; Stanislas Smajda; Carlos Riquelme; Oguzhan Coskun; Jean-Philippe Desilles; Frédéric Bourdain; Roberto Riva; Mikael Obadia; Francis Turjman; Georges Rodesch; Pierre Labauge; Alain Bonafé; Mikael Mazighi; Vincent Costalat; Michel Piotin; Raphaël Blanc; Bertrand Lapergue

doi:10.1016/j.neurad.2017.01.013

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Mechanical thrombectomy for minor and mild stroke patients harboring large vessel occlusion in the anterior circulation: A multicenter case control study

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Mechanical thrombectomy for minor and mild stroke patients harboring large vessel occlusion in the anterior circulation: A multicenter case control study

Cyril Dargazanli, Caroline Arquizan, Arturo Consoli, Benjamin Gory, Omer Eker, Xavier Ayrignac, Jean-Pierre Decroix, Astrid Corlobé, Isabelle Mourand, Grégory Gascou, …

Journal of neuroradiology, Vol.44(2), pp.70-70

03/2017

DOI: https://doi.org/10.1016/j.neurad.2017.01.013

Résumé

Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. There is no proven effectiveness of MT in the subgroup of minor stroke with LVO in the anterior circulation and data about mechanical thrombectomy (MT) in this subgroup of patients are sparse, with optimal management of these patients being yet not definitely addressed. The purpose of this case-control study was to evaluate MT in patients suffering from acute ischemic stroke (AIS) and LVO in the anterior circulation, presenting with minor to mild stroke symptoms (NIHSS<8). Case-control study involving 4 comprehensive stroke centers, having two approaches regarding management of minor and mild AIS patients harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0–1 at 3 months. In total, 301 patients were included, 170 with MT associated to best medical management (BMM, case group) and 131 with BMM alone as first line treatment (control group). Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.3%) belonging to the medical group had rescue MT due to neurologic worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the two groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size. Patients having underwent MT or BMM achieve excellent and favorable functional outcome at 3 months in similar proportions. However, baseline characteristics were different between the 2 groups, highlighting the urgent need for randomized clinical trials in this subset of patients.

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Titre: Mechanical thrombectomy for minor and mild stroke patients harboring large vessel occlusion in the anterior circulation: A multicenter case control study
Créateurs - sans rôle: Cyril Dargazanli - Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Caroline Arquizan - Department of neurology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Arturo Consoli - Department of interventional neuroradiology, Foch hospital, Versailles Saint-Quentin-en-Yvelines university, Suresnes, France
Benjamin Gory - Department of interventional neuroradiology, Pierre-Wertheimer hospital, Lyon-Bron, France
Omer Eker - Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Xavier Ayrignac - Department of neurology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Jean-Pierre Decroix - Department of neurology, Foch hospital, Versailles Saint-Quentin-en-Yvelines university, Suresnes, France
Astrid Corlobé - Department of neurology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Isabelle Mourand - Department of neurology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Grégory Gascou - Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Mahmoud Charif - Department of neurology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Julien Labreuche - Centre Hospitalier Universitaire de Lille
Alain Duhamel - Department of biostatistics, université de Lille, CHU de Lille, EA 2694–santé publique: épidémiologie et qualité des soins, 59000 Lille, France
Paul-Emile Labeyrie - Department of interventional neuroradiology, Pierre-Wertheimer hospital, Lyon-Bron, France
Hocine Redjem - Department of interventional neuroradiology, Rothschild foundation, Paris, France
Gabriele Ciccio - Department of interventional neuroradiology, Rothschild foundation, Paris, France
Stanislas Smajda - Department of interventional neuroradiology, Rothschild foundation, Paris, France
Carlos Riquelme - Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Oguzhan Coskun - Department of interventional neuroradiology, Foch hospital, Versailles Saint-Quentin-en-Yvelines university, Suresnes, France
Jean-Philippe Desilles - Department of interventional neuroradiology, Rothschild foundation, Paris, France
Frédéric Bourdain - Department of neurology, Foch hospital, Versailles Saint-Quentin-en-Yvelines university, Suresnes, France
Roberto Riva - Department of interventional neuroradiology, Pierre-Wertheimer hospital, Lyon-Bron, France
Mikael Obadia - Department of neurology, Rothschild foundation, Paris, France
Francis Turjman - Department of interventional neuroradiology, Pierre-Wertheimer hospital, Lyon-Bron, France
Georges Rodesch - Department of interventional neuroradiology, Foch hospital, Versailles Saint-Quentin-en-Yvelines university, Suresnes, France
Pierre Labauge - Department of neurology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Alain Bonafé - Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Mikael Mazighi - Department of interventional neuroradiology, Rothschild foundation, Paris, France
Vincent Costalat - Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, Montpellier, France
Michel Piotin - Department of interventional neuroradiology, Rothschild foundation, Paris, France
Raphaël Blanc - Department of interventional neuroradiology, Rothschild foundation, Paris, France
Bertrand Lapergue - Department of neurology, Foch hospital, Versailles Saint-Quentin-en-Yvelines university, Suresnes, France
Détails de publication: Journal of neuroradiology, Vol.44(2), pp.70-70
Éditeur: Elsevier Masson SAS
Nombre de pages: 1
Identifiants: 99155133009311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article