TY - JOUR
T1 - Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory
AU - Faizy, Tobias D
AU - Yedavalli, Vivek
AU - Salim, Hamza Adel
AU - Lakhani, Dhairya A
AU - Musmar, Basel
AU - Adeeb, Nimer
AU - Essibayi, Muhammed Amir
AU - Daraghma, Motaz
AU - El Naamani, Kareem
AU - Henninger, Nils
AU - Sundararajan, Sri Hari
AU - Kuhn, Anna Luisa
AU - Khalife, Jane
AU - Ghozy, Sherief
AU - Scarcia, Luca
AU - Yeo, Leonard Ll
AU - Tan, Benjamin Yq
AU - Regenhardt, Robert W
AU - Heit, Jeremy Josef
AU - Cancelliere, Nicole M
AU - Rouchaud, Aymeric
AU - Fiehler, Jens
AU - Sheth, Sunil A
AU - Puri, Ajit S
AU - Dyzmann, Christian
AU - Colasurdo, Marco
AU - Renieri, Leonardo
AU - Filipe, João Pedro
AU - Harker, Pablo
AU - Radu, Răzvan Alexandru
AU - Abdalkader, Mohamad
AU - Klein, Piers
AU - Marotta, Thomas R
AU - Spears, Julian
AU - Ota, Takahiro
AU - Mowla, Ashkan
AU - Jabbour, Pascal
AU - Biswas, Arundhati
AU - Clarençon, Frédéric
AU - Siegler, James E
AU - Nguyen, Thanh N
AU - Varela, Ricardo
AU - Baker, Amanda
AU - Altschul, David
AU - Gonzalez, Nestor
AU - Möhlenbruch, Markus A
AU - Costalat, Vincent
AU - Gory, Benjamin
AU - Hecker, Constantin
AU - Griessenauer, Christoph J
AU - MAD MT Investigators
A2 - Killer-Oberpfalzer, Monika
N1 - Hecker, Griessenauer: Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria; MKO: study group member
PY - 2025/1/23
Y1 - 2025/1/23
N2 - BACKGROUND: Current randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown.METHODS: This was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. Only patients with occlusion of the distal branches (M2 and M3) of the middle cerebral artery territory were included. Unsuccessful MT was defined as a modified Thrombolysis in Cerebral Infarction score of 0-2a. Propensity score matching was used to control for confounders. The primary outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days after treatment. Multivariable regression analysis was used to assess factors associated with the primary outcome.RESULTS: Of 2903 patients screened for eligibility, 532 patients were analyzed (266 per group) after propensity score matching. The MM group had superior functional outcomes, with 32% achieving mRS 0-1 at 90 days compared with 21% in the MT group (P=0.011). Patients in the MM group also had significantly lower rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 16%, P<0.001) and any hemorrhage (18% vs 48%, P<0.001). On multivariable regression, unsuccessful MT was associated with reduced odds of functional independence (OR 0.50, 95% CI 0.29 to 0.85, P=0.011) and increased odds of sICH (OR 4.32, 95% CI 1.84 to 10.10, P<0.001). Mortality rates were similar between groups (27% in MM vs 29% in MT, P=0.73).CONCLUSION: Unsuccessful MT for MeVO was linked to worse outcomes than best MM. These findings highlight the risks of prolonged attempts and emphasize the importance of efficient procedural decision-making to reduce complications and improve patient outcomes.
AB - BACKGROUND: Current randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown.METHODS: This was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. Only patients with occlusion of the distal branches (M2 and M3) of the middle cerebral artery territory were included. Unsuccessful MT was defined as a modified Thrombolysis in Cerebral Infarction score of 0-2a. Propensity score matching was used to control for confounders. The primary outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days after treatment. Multivariable regression analysis was used to assess factors associated with the primary outcome.RESULTS: Of 2903 patients screened for eligibility, 532 patients were analyzed (266 per group) after propensity score matching. The MM group had superior functional outcomes, with 32% achieving mRS 0-1 at 90 days compared with 21% in the MT group (P=0.011). Patients in the MM group also had significantly lower rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 16%, P<0.001) and any hemorrhage (18% vs 48%, P<0.001). On multivariable regression, unsuccessful MT was associated with reduced odds of functional independence (OR 0.50, 95% CI 0.29 to 0.85, P=0.011) and increased odds of sICH (OR 4.32, 95% CI 1.84 to 10.10, P<0.001). Mortality rates were similar between groups (27% in MM vs 29% in MT, P=0.73).CONCLUSION: Unsuccessful MT for MeVO was linked to worse outcomes than best MM. These findings highlight the risks of prolonged attempts and emphasize the importance of efficient procedural decision-making to reduce complications and improve patient outcomes.
U2 - 10.1136/jnis-2024-022642
DO - 10.1136/jnis-2024-022642
M3 - Original Article
C2 - 39855674
SN - 1759-8478
JO - JOURNAL OF NEUROINTERVENTIONAL SURGERY
JF - JOURNAL OF NEUROINTERVENTIONAL SURGERY
ER -