Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study

Hamza Adel Salim; Vivek Yedavalli; Dhairya A. Lakhani; Fathi Milhem; Basel Musmar; Nimer Adeeb; Tobias D. Faizy; Motaz Daraghma; Kareem El Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kuhn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Inayat Grewal; Leonard L. L. Yeo; Benjamin Y. Q. Tan; Robert W. Regenhardt; Jeremy Josef Heit; 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; Muhammed Amir Essibayi; David Altschul; Nestor 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 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-2024-022570

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Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study

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Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study

Hamza Adel Salim, Vivek Yedavalli, Dhairya A. Lakhani, Fathi Milhem, Basel Musmar, Nimer Adeeb, Tobias D. Faizy, Motaz Daraghma, Kareem El Naamani, Nils Henninger, …

Journal of neurointerventional surgery, Vol.18(1), pp.186-194

05/03/2025

DOI: https://doi.org/10.1136/jnis-2024-022570

PMID: 40044412

Résumé

Life Sciences & Biomedicine

Neuroimaging

Neurosciences & Neurology

Science & Technology

Surgery

Background Mechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines the impact of periprocedural embolization to a new vascular territory (ENT) on clinical outcomes in patients with MeVO stroke treated with MT.Methods A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke who underwent MT between September 2017 and July 2023. ENT was defined as filling defects in previously unaffected territories, excluding embolization near the original occlusion, observed on final angiographic runs after retrieval of the primary thrombus. The associations between ENT, procedural variables, and 90-day clinical outcomes were evaluated, including functional independence (modified Rankin Scale (mRS) scores of 0-2), excellent outcomes (mRS 0-1), mortality, and hemorrhagic complications.Results ENT occurred in 2.9% (63/2122) of patients. Longer onset-to-arterial puncture time (adjusted OR 1.03; 95% CI 1.01 to 1.05; P=0.002) and a greater number of passes (adjusted OR 1.15; 95% CI 1.01 to 1.32; P=0.032) were associated with increased ENT risk, while excellent recanalization (thrombolysis in cerebral infarction (TICI) scale score 2c-3) was associated with reduced ENT risk (adjusted OR 0.41; 95% CI 0.23 to 0.72; P=0.002). ENT was not associated with poorer functional independence, mortality, or hemorrhagic complications.Conclusions ENT during MT for MeVO stroke occurs infrequently and does not significantly affect the clinical outcomes. These findings suggest ENT risk should not deter clinicians from performing MT in patients with MeVO. Further prospective studies are needed to validate these results.

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Titre: Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study
Créateurs - sans rôle: Hamza Adel Salim - College Station Medical Center
Vivek Yedavalli - College Station Medical Center
Dhairya A. Lakhani - Johns Hopkins Med Ctr, Dept Radiol, Div Neuroradiol, Baltimore, MD 21044 USA
Fathi Milhem - Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA 02115 USA
Basel Musmar - Thomas Jefferson University
Nimer Adeeb - Louisiana State University
Tobias D. Faizy - Univ Med Ctr Munster, Dept Radiol, Neuroendovasc Program, Munster, Germany
Motaz Daraghma - Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA 02115 USA
Kareem El Naamani - Thomas Jefferson University
Nils Henninger - Univ Massachusetts, Dept Neurol, Chan Med Sch, Worcester, MA USA
Sri Hari Sundararajan - 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
Inayat Grewal - MD Anderson Med Ctr, Dept Neuroradiol, Houston, TX 77030 USA
Leonard L. L. Yeo
Benjamin Y. Q. Tan
Robert W. Regenhardt - Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA 02115 USA
Jeremy Josef Heit - College Station Medical Center
Nicole M. Cancelliere - University of Toronto
Aymeric Rouchaud - Univ Limoges, Univ Hosp Limoges, Neuroradiol Dept, Limoges, France
Jens Fiehler - Ctr Hosp Univ Porto, Dept Diagnost & Intervent Neuroradiol, Porto, Portugal
Sunil A. Sheth - UTHlth McGovern Med Sch, Dept Neurol, Houston, TX USA
Ajit S. Puri - College Station Medical Center
Christian Dyzmann - Sana Kliniken, Neuroradiol Dept, Lubeck, Germany
Marco Colasurdo - University of Portland
Leonardo Renieri - Osped Careggi Firenze, Interventist Neurovascolare, Florence, Italy
Joao Pedro Filipe - Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany
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 - University of Toronto
Julian Spears - Univ Toronto, Neurovasc Ctr, Div Therapeut Neuroradiol, 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 & Endovasc Neurosurg, Los Angeles, CA USA
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - New York Medical College
Frederic Clarencon - Sorbonne Univ, Pitie Salpetriere Hosp, Dept Neuroradiol, Paris, France
James E. Siegler - Rowan University
Thanh N. Nguyen - Boston Med Ctr, Dept Neurol, Boston, MA USA
Ricardo Varela - Ctr Hosp Univ Porto, Dept Neurol, Porto, Portugal
Amanda Baker - Albert Einstein College of Medicine
Muhammed Amir Essibayi - Albert Einstein College of Medicine
David Altschul - Albert Einstein College of Medicine
Nestor Gonzalez - College Station Medical Center
Markus A. Mohlenbruch
Vincent Costalat - Montpellier Univ, Gui de Chauliac Hosp, Dept Neuroradiol, Med Ctr, 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 - Rowan University
Christoph J. Griessenauer - University of Salzburg
David S. Liebeskind - UCLA, UCLA Stroke Ctr, Los Angeles, CA USA
Alessandro Pedicelli - Fdn Policlin Univ A Gemelli IRCCS, UOSA Neuroradiol Interventist, Rome, Italy
Andrea Maria Alexandre - Fdn Policlin Univ A Gemelli IRCCS, UOSA Neuroradiol Interventist, Rome, Italy
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
Aman B. Patel - Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA 02115 USA
Vitor Mendes Pereira - University of Toronto
Max Wintermark - MD Anderson Med Ctr, Dept Neuroradiol, Houston, TX 77030 USA
Adrien Guenego - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Adam A. Dmytriw - Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA 02115 USA
MAD MT Investigators
MAD MT Investigators
Détails de publication: Journal of neurointerventional surgery, Vol.18(1), pp.186-194
Éditeur: Bmj Publishing Group
Nombre de pages: 9
Identifiants: 99162977209311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article