Outcomes of mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke patients with ASPECTS 4–5 vs. 6–7: a retrospective, multicenter, and multinational study

Basel Musmar; Hamza Adel Salim; Nimer Adeeb; Vivek Yedavalli; Dhairya Lakhani; Kareem El Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kühn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Benjamin Y. Q. Tan; Robert W. Regenhardt; Jeremy J. Heit; Nicole M. Cancelliere; Joshua D. Bernstock; Aymeric Rouchaud; Jens Fiehler; Sunil Sheth; Ajit S. Puri; Christian Dyzmann; Marco Colasurdo; Xavier Barreau; Leonardo Renieri; João Pedro Filipe; Pablo Harker; Răzvan Alexandru Radu; Mohamad Abdalkader; Piers Klein; Thomas R. Marotta; Julian Spears; Takahiro Ota; Ashkan Mowla; Pascal Jabbour; Arundhati Biswas; Frédéric Clarençon; James E. Siegler; Thanh N. Nguyen; Ricardo Varela; Amanda Baker; Muhammed Amir Essibayi; David Altschul; Nestor R. Gonzalez; Markus A. Möhlenbruch; 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; for the MAD MT Investigators

doi:10.1007/s00234-024-03500-1

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Outcomes of mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke patients with ASPECTS 4–5 vs. 6–7: a retrospective, multicenter, and multinational study

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Outcomes of mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke patients with ASPECTS 4–5 vs. 6–7: a retrospective, multicenter, and multinational study

Basel Musmar, Hamza Adel Salim, Nimer Adeeb, Vivek Yedavalli, Dhairya Lakhani, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, …

Neuroradiology, Vol.67(1), pp.201-211

01/01/2025

DOI: https://doi.org/10.1007/s00234-024-03500-1

PMID: 39812774

Résumé

Imaging

Interventional Neuroradiology

Medicine

Medicine & Public Health

Neurology

Neuroradiology

Neurosciences

Neurosurgery

Radiology

Introduction Mechanical thrombectomy (MT) efficacy in medium vessel occlusion (MeVO) stroke, particularly in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), remains less explored. Methods This retrospective study analyzed data from 443 AIS patients treated with MT for MeVO and low ASPECTS (4–7) at 37 centers across North America, Asia, and Europe, from September 2017 to July 2021. Patients were categorized into ASPECTS of 4–5 and 6–7. Results Of 443 patients, 51 (12%) had ASPECTS of 4–5, and 392 (88%) had scores of 6–7. The median age was 65 years (IQR: 46–79), with a balanced sex distribution between the groups. The most common site of initial occlusion was M2 branch in both groups (92% in ASPECTS 4–5 and 85% in ASPECTS 6–7) ( p = 0.68). The ASPECTS 4–5 group had lower TICI 2c-3 achievement (31% vs. 55%, p = 0.002) and poorer functional outcomes (mRS 0–1 at 90 days: 12% vs. 29%, p = 0.03) compared to the ASPECTS 6–7 group. Intracranial hemorrhagic complications were higher in the ASPECTS 4–5 group (69% vs. 47%, p = 0.007). Multivariable analysis revealed ASPECTS 6–7 to be associated with higher odds of TICI 2c-3 (OR: 2.5; CI: 1.28 to 4.89, p = 0.007) and lower odds of intracranial hemorrhagic complications (OR: 0.4; CI: 0.19 to 0.81, p = 0.012). Conclusion MT may be associated with improved outcomes in patients with moderate-to-low ASPECTS (6–7), though the lack of a control group limits definitive conclusions about its effectiveness. In patients with very low ASPECTS (4–5), higher rates of hemorrhagic complications and poorer outcomes were observed, but this does not necessarily preclude the use of MT. These findings highlight the need for further research and careful patient selection.

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Titre: Outcomes of mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke patients with ASPECTS 4–5 vs. 6–7: a retrospective, multicenter, and multinational study
Créateurs - sans rôle: Basel Musmar - Louisiana State University
Hamza Adel Salim - Brigham and Women's Hospital
Nimer Adeeb - Louisiana State University
Vivek Yedavalli - Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center
Dhairya Lakhani - Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University
Kareem El Naamani - Thomas Jefferson University
Nils Henninger - University of Massachusetts Chan Medical School
Sri Hari Sundararajan - Department of Endovascular Neurosurgery and Neuroradiology NJMS
Anna Luisa Kühn - Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center
Jane Khalife - Cooper University Hospital
Sherief Ghozy - Neurological Surgery
Luca Scarcia - Department of Neuroradiology, Henri Mondor Hospital
Benjamin Y. Q. Tan - Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Division of Neurology, Department of Medicine, National University Hospital
Robert W. Regenhardt - Brigham and Women's Hospital
Jeremy J. Heit - Department of Interventional Neuroradiology, Stanford Medical Center
Nicole M. Cancelliere - Toronto Metropolitan University
Joshua D. Bernstock - Brigham and Women's Hospital
Aymeric Rouchaud - University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252
Jens Fiehler - University Medical Center Hamburg-Eppendorf
Sunil Sheth - The University of Texas Health Science Center at Houston
Ajit S. Puri - Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center
Christian Dyzmann - Neuroradiology Department, Sana KlinikenLübeck GmbH
Marco Colasurdo - Department of Interventional Radiology, Oregon Health and Science University
Xavier Barreau - Interventional Neuroradiology Department, Bordeaux University Hospital
Leonardo Renieri - Interventistica Neurovascolare, Ospedale Careggi Di Firenze
João Pedro Filipe - Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário Do Porto
Pablo Harker - University of Cincinnati Medical Center
Răzvan Alexandru Radu - Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center
Mohamad Abdalkader - Boston Medical Center
Piers Klein - Boston Medical Center
Thomas R. Marotta - Toronto Metropolitan University
Julian Spears - Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael’s Hospital, Toronto Metropolitan University
Takahiro Ota - Tokyo Metropolitan Tama Medical Center
Ashkan Mowla - Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC)
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - Westchester Medical Center
Frédéric Clarençon - Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast. Sorbonne University. Paris VI
James E. Siegler - Cooper University Hospital
Thanh N. Nguyen - Department of Radiology & Neurology, Boston Medical Center
Ricardo Varela - Department of Neurology, Centro Hospitalar Universitário Do Porto
Amanda Baker - Albert Einstein College of Medicine
Muhammed Amir Essibayi - Albert Einstein College of Medicine
David Altschul - Albert Einstein College of Medicine
Nestor R. Gonzalez - Cedars-Sinai Medical Center
Markus A. Möhlenbruch - Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg
Vincent Costalat - Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center
Benjamin Gory - Centre Hospitalier Régional et Universitaire de Nancy
Christian Paul Stracke - Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster
Mohammad Ali Aziz-Sultan - Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School
Constantin Hecker - Paracelsus Medical University
Hamza Shaikh - Cooper University Hospital
David S. Liebeskind - UCLA Stroke Center and Department of Neurology Department, UCLA
Alessandro Pedicelli - UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS
Andrea M. Alexandre - UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS
Illario Tancredi - Department of Neurology, Hôpital Civil Marie Curie
Tobias D. Faizy - Department of Radiology, Neuroendovascular Program, University Medical Center Münster
Erwah Kalsoum - Department of Neuroradiology, Henri Mondor Hospital
Boris Lubicz - Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital
Aman B. Patel - Brigham and Women's Hospital
Vitor Mendes Pereira - Toronto Metropolitan University
Adrien Guenego - Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital
Adam A. Dmytriw - Toronto Metropolitan University
for the MAD MT Investigators
Détails de publication: Neuroradiology, Vol.67(1), pp.201-211
Éditeur: Springer Berlin Heidelberg
Nombre de pages: 11
Identifiants: 99163018909311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article