Safety and effectiveness of SOFIA/SOFIA PLUS for direct aspiration as first line treatment in patients with acute anterior ischemic stroke: results from the prospective, multicentric SESAME study.

Background: Mechanical thrombectomy is a cornerstone treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO), yet the optimal technique remains debated. The SOFIA/SOFIA PLUS catheter has emerged as a promising tool for direct aspiration thrombectomy. Purpose: This prospective multi-center study, adhering Good-Clinical-Practice guidelines, aimed to evaluate the safety and efficacy of the SOFIA/SOFIA PLUS catheter for direct aspiration as a first-line treatment technique in patients with acute anterior circulation LVO. Materials and methods: Between 10/2017 and 12/2021, 246 consecutive patients presenting with AIS due to anterior circulation LVO were enrolled from 14 European centers. Primary treatment with SOFIA catheters was performed within 6 h of symptom onset. Clinical and radiological data were collected, and statistical analyses were conducted. Results: The mean age of the included patients was 71.6 ± 13.9 years, with 44.7% being male. Primary aspiration achieved complete recanalization in 72.8% of patients, with functional independence observed in 63.8% after 90 days. Secondary outcomes included a median NIHSS of 4 at 24 h post-procedure, median ASPECTS of 7 on follow-up imaging, and a mortality rate of 24.4% at 90 days. No device malfunctions were observed, and the rate of symptomatic intracranial hemorrhage was 4.4%. Conclusion: Primary aspiration with the SOFIA/SOFIA PLUS catheter demonstrates favorable safety and efficacy profiles in the treatment of anterior circulation LVO. These findings support the utilization of this technique as a first-line approach in mechanical thrombectomy for AIS, contributing to the growing body of evidence endorsing the effectiveness of direct aspiration thrombectomy in stroke management.

Lower Healthcare Access and Its Association With Individual Factors and Health-Related Quality of Life in Adults With Rare Diseases in Switzerland.

Objectives: This study aims to determine clusters of access to healthcare among adults with rare diseases in Switzerland, identify associated individual characteristics of access, and impact on health-related quality of life (HRQoL). Methods: Swiss adults (N = 341) diagnosed with a rare disease completed an online survey including the Perception of Access to Healthcare Questionnaire (PAHQ) and Short Form Health Survey (SF-12). We employed partition around medoids algorithm to identify patient clusters based on the PAHQ. Various sociodemographic/disease-related factors and HRQoL were assessed. Results: We identified two patient clusters: higher (n = 227) and lower access (n = 114). Significantly associated with lower access were an unstable disease course (p < 0.05), increased number of misdiagnoses (p < 0.05), and diseases affecting the nervous system (p < 0.01). Membership in the lower access cluster was significantly associated with worse HRQoL (p < 0.05). Conclusion: Findings highlight the need for comprehensive assessment of healthcare access in adults with rare diseases and identifies potential targets for tailored interventions.

Patient sex and use of tranexamic acid in liver transplantation.

Background: Differences in medical treatment between women and men are common and involve out-of-hospital emergency care, the intensity of pain treatment, and the use of antifibrinolytic treatment in emergency trauma patients. If woman and man receive different antifibrinolytic treatment in highly-standardized major transplant surgery is unknown. Methods: We conducted a retrospective cohort study on patients who underwent liver transplantation at Heidelberg University Hospital, Heidelberg, Germany between 2004 and 2017. Logistic regression analyses were performed to determine if sex is associated with the administration of TXA during liver transplantation. Secondary endpoints included venous thrombotic complications, graft failure, mortality, myocardial infarction, hepatic artery thrombosis, and stroke within the first 30 days after liver transplant as well as length of hospital stay and length of intensive care unit stay. Results: Out of 779 patients who underwent liver transplantation, 262 patients received TXA. Female sex was not associated with intraoperative administration of TXA [adjusted OR: 0.929 (95% CI 0.654; 1.320), p = 0.681]. The secondary endpoints graft failure (13.2% vs. 8.4%, women vs. men, p = 0.039), pulmonary embolism (3.4% vs. 0.9%, women vs. men, p = 0.012), stroke (1.7% vs. 0.4%, women vs. men, p = 0.049), and deep vein thrombosis (0.8% vs. 0%, women vs. men, p = 0.031) within 30 days after liver transplantation were more frequent in women. Mortality, myocardial infarction, and other secondary endpoints did not differ between groups. However, in women, the use of TXA was associated with a lower rate in thromboembolic complications. Conclusion: Our data indicate that different from other scenarios with massive bleeding complications the administration of TXA during liver transplantation is not associated with sex. However, sex is associated with the risk for complications, and in woman TXA might have a preventive effect on the rate of thromboembolic complications. Reasons underlying the observed sex bias rate remain uncertain.

Beyond the Surface: Interconnection of Viscosity, Crystal Growth, and Diffusion in Ge25Se75 Glass-Former.

The knowledge of viscosity behavior, crystal growth phenomenon, and diffusion is important in producing, processing, and practical applications of amorphous solids prepared in different forms (bulk glasses and thin films). This work uses microscopy to study volume crystal growth in Ge25Se75 bulk glasses and thermally evaporated thin films. The collected growth data measured over a wide temperature range show a significant increase in crystal growth rates in thin films. The crystal growth is analyzed using near-surface viscosities obtained in bulks and thin films using nanoindentation and melt viscosities measured by a pressure-assisted melt filling technique. The crystal growth analysis provides information on the size of the structural units incorporated into the growing crystals, essential for estimating the diffusion coefficients and explaining the difference in crystal growth rates in bulk and thin films. The crystal growth analysis also reveals the decoupling between diffusion and viscous flow described by the Stokes-Einstein-Eyring relation. Moreover, to the authors' best knowledge, the manuscript provides the first evaluation estimation of the effective self-diffusion coefficient directly from growth data in chalcogenide glass-formers. The present data show a similar relation between diffusion coefficients (D) and crystal growth rates (u): u ≈ D0.87, which is found in several molecular glasses.

Longitudinal relationship between posttraumatic cognitions and internalising symptoms in children and adolescents.

Background: Little is known about the naturalistic course of posttraumatic cognitions (PTCs) after exposure to a potentially traumatic event (PTE) in children and adolescents. Moreover, previous studies on the longitudinal associations of PTCs with internalising symptoms yielded mixed results.Objective: To explore the naturalistic courses and longitudinal associations of dysfunctional PTCs and functional PTCs with posttraumatic stress symptoms (PTSS), depression, and anxiety.Method: A total of 115 children and adolescents, aged 7-15 years, were assessed within 1 month, 3 months, and 6 months after exposure to an acute accidental PTE. Repeated measures analyses of variance were conducted to capture the naturalistic courses of PTCs and internalising symptoms. Cross-lagged panel analyses were applied to explore the longitudinal relationship between dysfunctional and functional PTCs, along with their longitudinal associations with PTSS, depression, and anxiety.Results: Dysfunctional PTCs and internalising symptoms decreased, whereas functional PTCs increased over time. Dysfunctional and functional PTCs were moderately inversely related, but no significant cross-lagged paths emerged among them. Dysfunctional PTCs were moderately to strongly associated with internalising symptoms, while functional PTCs were weakly to moderately inversely associated with internalising symptoms. Initial PTSS predicted later dysfunctional PTCs (ß = .31, p < .05), but not vice versa.Conclusions: Dysfunctional PTCs, functional PTCs, and internalising symptoms were entangled over time. Our findings support the cognitive scar model with initial PTSS predicting later dysfunctional PTCs. Future research complementing between-subject with within-subject analyses could offer additional insights into the longitudinal relationship between dysfunctional PTCs, functional PTCs, and psychological symptoms.

Dysfunctional posttraumatic cognitions and internalising symptoms naturally decreased, whereas functional posttraumatic cognitions naturally increased over a 6-month period following exposure to an acute accidental potentially traumatic event.Above the significant longitudinal associations of dysfunctional posttraumatic cognitions with internalising symptoms, functional posttraumatic cognitions were significantly inversely related to internalising symptoms over time.Posttraumatic stress symptoms assessed within 1 month after the potentially traumatic event predicted dysfunctional posttraumatic cognitions assessed 3 months after the potentially traumatic event, but not vice versa.

Safety and efficacy of coated flow diverters in the treatment of cerebral aneurysms during single antiplatelet therapy: A multicenter study.

OBJECTIVE: This multicenter study evaluates the safety and efficacy of coated flow diverters (cFDs) for the treatment of cerebral aneurysms under single antiplatelet therapy (SAPT). METHODS: This is a retrospective, observational study of 41 patients (median age: 58 years) with 41 aneurysms (median size: 7 mm, 29 [71%] saccular, 9 [22%] ruptured) treated with cFDs at four neurovascular centers between 2020 and 2023. Scheduled cases received continuous SAPT starting seven days before the procedure. Emergency cases were treated with tirofiban followed by SAPT loading. The safety endpoint was ischemic complications occurring during the procedure and within four months of clinical follow-up. RESULTS: The Pipeline Vantage or Flex Shield was used in 26 (63%) procedures, the FRED X in 12 (29%), the p48/64 Hydrophilic Polymer Coating in 2 (5%), and the Derivo Embolization Device 2heal in 1 (2%). Single antiplatelet therapy consisted of prasugrel in 27 (66%) patients, ticagrelor in 9 (22%), and ASA in 5 (12%). There were 2 (5%) early ischemic complications (one minor stroke and one transient ischemic attack). There were no late ischemic complications in the four-month follow-up of 35 patients. The six dropouts included four nontreatment-related deaths after subarachnoid hemorrhage and two patients with a poor outcome after subarachnoid hemorrhage. Complete and favorable occlusion rates (median: 7 months) were 75% (27/36) and 89% (32/36), respectively. CONCLUSIONS: Coated flow diverter implantation in the setting of SAPT was safe and effective and warrants confirmation in a prospective comparative trial.

Laryngeal mask vs. laryngeal tube trial in paediatric patients (LaMaTuPe): a single-blinded, open-label, randomised-controlled trial.

BACKGROUND: In hypoxemic children with difficult airway, or for minor elective procedures, the use of a supraglottic airway device may be preferred to endotracheal intubation, whether with a laryngeal mask or laryngeal tube. Second-generation laryngeal masks may offer a better safety profile. Whether they should be preferred to laryngeal tubes is unknown. This study aimed to compare the efficacy and safety of second-generation laryngeal masks and laryngeal tubes in children. METHODS: This randomised-controlled trial was conducted in a single university hospital in children <18 years undergoing elective anaesthesia in urology, minor paediatric surgery and gynaecology. Patients were 1 : 1 randomised to the laryngeal mask or laryngeal tube group. Children were allocated a second-generation laryngeal tube or a second-generation laryngeal mask as the primary airway device. The primary endpoint was insertion time. Secondary endpoints included first-attempt success, overall success and complications, which included hypoxia (SpO2 < 90%), laryngospasm, bronchospasm, aspiration and bleeding. RESULTS: In total, 135 patients were randomised, with 61 allocated to the laryngeal tube and 74 to the laryngeal mask group, with a median age of 5.4 and 4.9 years, respectively. Median insertion time was significantly longer in the laryngeal tube group (37 vs. 31 s; difference of medians: 6.0 s; 95% confidence interval: 0.0-13.0). The laryngeal tube had a significantly lower first-attempt (41.0%) and overall success rate (45.9%) than the laryngeal mask (90.5% and 97.3%, respectively). Those allocated to the laryngeal tube group had a higher ratio of complications (27.8%) compared to the laryngeal mask group (2.7%). CONCLUSION: This randomised-controlled trial reported that in children undergoing elective anaesthesia, the use of a laryngeal tube was associated with a longer insertion time.

Prevalence of relevant early complications during the first 24 h on a normal ward in patients following PACU care after medium and major surgery: a monocentric retrospective observational study.

PURPOSE: Even today, it remains a challenge for healthcare professionals to decide whether a clinically stable patient who is recovering from uncomplicated medium or major surgery would benefit from a postoperative intensive care unit (ICU) admission, or whether they would be at least as adequately cared for by a few hours of monitoring in the post-operative care unit (PACU). METHODS: In this monocentric retrospective observational study, all adult patients who (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) in Anästh Intensivmed (50):S486-S489, 2009) underwent medium or major surgery between 1 January 1 2014 and 31 December 2018 at the Heidelberg University Surgical Center, and (Vimlati et al. in Eur J Anaesthesiol September 26(9):715-721, 2009) were monitored for 1-12 h in the PACU, and then (De Pietri et al. in World J Gastroenterol 20(9):2304-23207, 2014) transferred to a normal ward (NW) immediately thereafter were included. At the end of the PACU stay, each patient was cleared by both a surgeon and an anesthesiologist to be transferred to a NW. The first objective of this study was to determine the prevalence of relevant early complications (RECs) within the first 24 h on a normal ward. The secondary objective was to determine the prevalence of RECs in the subgroup of included patients who underwent partial pancreaticoduodenectomy. RESULTS: A total of 10,273 patients were included in this study. The prevalence of RECs was 0.50% (confidence interval [CI] 0.40-0.60%), with the median length of stay in the PACU before the patient's first transfer to a NW being 285 min (interquartile range 210-360 min). In the subgroup of patients who underwent partial pancreaticoduodenectomy (n = 740), REC prevalence was 1.1% (CI = 0.55-2.12%). CONCLUSION: Based on a medical case-by-case assessment, it is possible to select patients who after a PACU stay of only up to 12 h have a low risk of emergency readmission to an ICU within the 24 h following the transfer to the NW. Continued research will be needed to further improve transfer decisions in such low-risk subgroups.

[Inspection of deceased : Issuing a death certificate]. / Prähospitale Leichenschau : Durchführung und das Ausstellen der Todesbescheinigung.

The obligatory post-mortem examination and the issuing of a death certificate are among the more unpopular medical tasks. Nevertheless, the legislature has entrusted the medical profession with a socially important task that should be carried out carefully. The examining physician decides whether the death remains a private matter or whether an official death investigation should first shed light on the circumstances of the death. The post-mortem examination system is the only instrument for the systematic detection of homicide offences. The prerequisite for issuing a death certificate is a carefully conducted external post-mortem examination, which must be carried out in full at least when certifying a natural or unexplained cause of death. In addition, the medical information on the death certificate serves epidemiological and health policy purposes and contains important information on infection control.

A comparative analysis of planarian genomes reveals regulatory conservation in the face of rapid structural divergence.

The planarian Schmidtea mediterranea is being studied as a model species for regeneration, but the assembly of planarian genomes remains challenging. Here, we report a high-quality haplotype-phased, chromosome-scale genome assembly of the sexual S2 strain of S. mediterranea and high-quality chromosome-scale assemblies of its three close relatives, S. polychroa, S. nova, and S. lugubris. Using hybrid gene annotations and optimized ATAC-seq and ChIP-seq protocols for regulatory element annotation, we provide valuable genome resources for the planarian research community and a first comparative perspective on planarian genome evolution. Our analyses reveal substantial divergence in protein-coding sequences and regulatory regions but considerable conservation within promoter and enhancer annotations. We also find frequent retrotransposon-associated chromosomal inversions and interchromosomal translocations within the genus Schmidtea and, remarkably, independent and nearly complete losses of ancestral metazoan synteny in Schmidtea and two other flatworm groups. Overall, our results suggest that platyhelminth genomes can evolve without syntenic constraints.

Effects of Oxiris® Therapy on Cytokine Elimination after a LPS Infusion-An Experimental Animal Study.

The clinical effectiveness of Oxiris®, particularly in reducing cytokines, remains uncertain due to the limited data provided. This study explored and analyzed the application value of Oxiris® endotoxin adsorption technology in a large animal model. Pigs received an intravenous LPS infusion. Six animals were treated 2 h after the infusion with an Oxiris® hemadsorption using a pumpless extracorporeal technique for 6 h. Five animals served as controls. Cardiocirculatory parameters, hyperspectral analysis, and a panel of cytokines were measured. The lipopolysaccharide infusion induced sepsis-like inflammation with tachycardia, elevated pulmonary pressure, elevated lactate level, as well as elevated pro-inflammatory cytokines like interferon (IFN)-γ, interleukin (IL)-1ß, IL-2, IL-6, IL-8, IL-12 and tumor necrosis factor alpha (TNF-α). In addition, increases of anti-inflammatory cytokines like IL-1ra and IL-10 were found. After 3 and 6 h in both groups, pro-inflammatory cytokines were significantly reduced. No differences between the intervention and the control group could be detected after 3 and 6 h for IL-1ß, IL-2, IL-6, IL-8, IL-12 and TNF-α, suggesting no effect of the Oxiris® filter on the elimination of elevated cytokines with a pumpless extracorporeal hemadsorption technique. The presented large animal model may be a promising option for studying the effects of hemadsorption techniques.

Latent profiles and predictors of barriers to care in Swiss children and adolescents with rare diseases.

OBJECTIVE: Children and adolescents with rare diseases face significant barriers when accessing healthcare. We aimed to assess and predict these barriers and investigate associations with health-related quality of life (HRQoL). METHOD: We conducted a cross-sectional survey of Swiss parents (N = 189) of children with rare diseases including the Barriers to Care Questionnaire (BCQ), containing six barriers and the Pediatric Quality of Life Inventory (PedsQL). Latent profile analysis (LPA) was used to uncover distinct classes, which were compared using chi-square tests and Mann-Whitney U tests. Relevant medical and sociodemographic class predictors were identified using Elastic Net regression, followed by regression analysis to investigate their role in predicting barriers to care and examine the effects of these classes on HRQoL. RESULTS: Two distinct groups were identified, a higher barriers class (59%) and a lower barriers class (41%). In the higher barriers class, participants showed elevated scores across all subscales and specifically on pragmatics and expectations. More barriers to care were linked to a nonstable disease course (OR = 2.27, p = .002) and a diagnosis after the age of 3 months (OR = 2.17, p = .006). Individuals in the higher barriers class exhibited more psychological comorbidities (p = .044), congenital malformations/deformations/chromosomal abnormalities (p=.042), and medical misdiagnoses (p = .006). Children in the higher barriers class had significantly lower PedsQL scores compared to the lower barriers class (p <.05). CONCLUSION: This study highlights the need for comprehensive assessment of barriers to pediatric care in rare diseases, offering potential entry points for targeted interventions.

Intraoperative end-tidal carbon dioxide levels are not associated with recurrence-free survival after elective pancreatic cancer surgery: a retrospective cohort study.

Background: Intraoperative end-tidal carbon dioxide concentrations (EtCO2) values are associated with recurrence-free survival after colorectal cancer surgery. However, it is unknown if similar effects can be observed after other surgical procedures. There is now evidence available for target EtCO2 and its relation to surgical outcomes following pancreatic cancer surgery. Methods: In this single-center, retrospective cohort study, we analyzed 652 patients undergoing elective resection of pancreatic cancer at Heidelberg University Hospital between 2009 and 2016. The entire patient cohort was sorted in ascending order based on mean intraoperative EtCO2 values and then divided into two groups: the high-EtCO2 group and the low-EtCO2 group. The pre-specified primary endpoint was the assessment of recurrence-free survival up to the last known follow-up. Cardiovascular events, surgical site infections, sepsis, and reoperations during the hospital stay, as well as overall survival were pre-specified secondary outcomes. Results: Mean EtCO2 was 33.8 mmHg ±1.1 in the low-EtCO2 group vs. 36.8 mmHg ±1.9 in the high-EtCO2 group. Median follow-up was 2.6 (Q1:1.4; Q3:4.4) years. Recurrence-free survival did not differ among the high and low-EtCO2 groups [HR = 1.043 (95% CI: 0.875-1.243), log rank test: p = 0.909]. Factors affecting the primary endpoint were studied via Cox analysis, which indicated no correlation between mean EtCO2 levels and recurrence-free survival [Coefficient -0.004, HR = 0.996 (95% CI:0.95-1.04); p = 0.871]. We did not identify any differences in the secondary endpoints, either. Conclusions: During elective pancreatic cancer surgery, anesthesiologists should set EtCO2 targets for reasons other than oncological outcome until conclusive evidence from prospective, multicenter randomized controlled trials is available.

In situ deposition of nanobodies by an engineered commensal microbe promotes survival in a mouse model of enterohemorrhagic E. coli.

Engineered smart microbes that deliver therapeutic payloads are emerging as treatment modalities, particularly for diseases with links to the gastrointestinal tract. Enterohemorrhagic Escherichia coli (EHEC) is a causative agent of potentially lethal hemolytic uremic syndrome. Given concerns that antibiotic treatment increases EHEC production of Shiga toxin (Stx), which is responsible for systemic disease, novel remedies are needed. EHEC encodes a type III secretion system (T3SS) that injects Tir into enterocytes. Tir inserts into the host cell membrane, exposing an extracellular domain that subsequently binds intimin, one of its outer membrane proteins, triggering the formation of attaching and effacing (A/E) lesions that promote EHEC mucosal colonization. Citrobacter rodentium (Cr), a natural A/E mouse pathogen, similarly requires Tir and intimin for its pathogenesis. Mice infected with Cr(ΦStx2dact), a variant lysogenized with an EHEC-derived phage that produces Stx2dact, develop intestinal A/E lesions and toxin-dependent disease. Stx2a is more closely associated with human disease. By developing an efficient approach to seamlessly modify the C. rodentium genome, we generated Cr_Tir-MEHEC(ΦStx2a), a variant that expresses Stx2a and the EHEC extracellular Tir domain. We found that mouse precolonization with HS-PROT3EcT-TD4, a human commensal E. coli strain (E. coli HS) engineered to efficiently secrete an anti-EHEC Tir nanobody, delayed bacterial colonization and improved survival after challenge with Cr_Tir-MEHEC(ΦStx2a). This study suggests that commensal E. coli engineered to deliver payloads that block essential virulence determinants can be developed as a new means to prevent and potentially treat infections including those due to antibiotic resistant microbes.

What secondary research evidence exists on the effects of forest management after disturbances: a systematic map protocol.

BACKGROUND: Forest disturbances are projected to increase in intensity and frequency in the upcoming decades. The projected change in disturbance regimes is expected to alter the provision of ecosystem services and affect biodiversity. Both are critical for forest ecosystems to provide livelihoods for human societies. Forest management after natural disturbances shapes successional pathways of forest ecosystems. Therefore, the management of post-disturbance sites deserves critical attention to avoid negative effects of management interventions on ecosystem services and biodiversity. The two most common management interventions after natural disturbances are salvage logging (comparator: no salvage logging) and tree planting (comparator: natural regeneration). This planned systematic map of reviews aims to aggregate the existing evidence syntheses on the implications of common forest management interventions after natural disturbances on successional trajectories with regard to selected ecosystem services and biodiversity. Evidence-based post-disturbance management is highly relevant for protected area management as well as for the management of commercial forests. METHODS: We will systematically search the databases Scopus, Web of Science Core Collection and the Forest Science Collection of the CABI Digital Library for reviews and meta-analyses (after 2003). We will apply eligibility criteria for review selection and assess the evidence synthesis validity of selected reviews using the most recent version of CEESAT (Collaboration for Environmental Evidence Synthesis Assessment Tool). The results will be displayed in topic subgroups in summary of scope and summary of findings tables.

Calorie restriction and rapamycin distinctly restore non-canonical ORF translation in the muscles of aging mice.

Loss of protein homeostasis is one of the hallmarks of aging. As such, interventions that restore proteostasis should slow down the aging process and improve healthspan. Two of the most broadly used anti-aging interventions that are effective in organisms from yeast to mammals are calorie restriction (CR) and rapamycin (RM) treatment. To identify the regulatory mechanisms by which these interventions improve the protein homeostasis, we carried out ribosome footprinting in the muscle of mice aged under standard conditions, or under long-term treatment with CR or RM. We found that the treatments distinctly impact the non-canonical translation, RM primarily remodeling the translation of upstream open reading frames (uORFs), while CR restores stop codon readthrough and the translation of downstream ORFs. Proteomics analysis revealed the expression of numerous non-canonical ORFs at the protein level. The corresponding peptides may provide entry points for therapies aiming to maintain muscle function and extend health span.

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

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.