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Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study.
Meyer, Lukas; Stracke, Paul; Broocks, Gabriel; Elsharkawy, Mohamed; Sporns, Peter; Piechowiak, Eike I; Kaesmacher, Johannes; Maegerlein, Christian; Hernandez Petzsche, Moritz Roman; Zimmermann, Hanna; Naziri, Weis; Abdullayev, Nuran; Kabbasch, Christoph; Diamandis, Elie; Thormann, Maximilian; Maus, Volker; Fischer, Sebastian; Möhlenbruch, Markus; Weyland, Charlotte S; Ernst, Marielle; Jamous, Ala; Meila, Dan; Miszczuk, Milena; Siebert, Eberhard; Lowens, Stephan; Krause, Lars Udo; Yeo, Leonard; Tan, Benjamin; Gopinathan, Anil; Arenillas-Lara, Juan F; Navia, Pedro; Raz, Eytan; Shapiro, Maksim; Arnberg, Fabian; Zelenák, Kamil; Martínez-Galdámez, Mario; Alexandrou, Maria; Kastrup, Andreas; Papanagiotou, Panagiotis; Kemmling, André; Dorn, Franziska; Psychogios, Marios; Andersson, Tommy; Chapot, René; Fiehler, Jens; Hanning, Uta.
Afiliação
  • Meyer L; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Stracke P; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Broocks G; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Elsharkawy M; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Sporns P; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Piechowiak EI; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Kaesmacher J; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Maegerlein C; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Hernandez Petzsche MR; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Zimmermann H; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Naziri W; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Abdullayev N; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Kabbasch C; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Diamandis E; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Thormann M; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Maus V; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Fischer S; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Möhlenbruch M; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Weyland CS; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Ernst M; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Jamous A; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Meila D; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Miszczuk M; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Siebert E; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Lowens S; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Krause LU; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Yeo L; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Tan B; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Gopinathan A; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Arenillas-Lara JF; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Navia P; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Raz E; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Shapiro M; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Arnberg F; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Zelenák K; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Martínez-Galdámez M; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Alexandrou M; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Kastrup A; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Papanagiotou P; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Kemmling A; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Dorn F; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Psychogios M; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Andersson T; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Chapot R; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Fiehler J; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
  • Hanning U; From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.);
Radiology ; 307(2): e220229, 2023 04.
Article em En | MEDLINE | ID: mdl-36786705
ABSTRACT
Background Evidence supporting a potential benefit of thrombectomy for distal medium vessel occlusions (DMVOs) of the anterior cerebral artery (ACA) is, to the knowledge of the authors, unknown. Purpose To compare the clinical and safety outcomes between mechanical thrombectomy (MT) and best medical treatment (BMT) with or without intravenous thrombolysis for primary isolated ACA DMVOs. Materials and Methods Treatment for Primary Medium Vessel Occlusion Stroke, or TOPMOST, is an international, retrospective, multicenter, observational registry of patients treated for DMVO in daily practice. Patients treated with thrombectomy or BMT alone for primary ACA DMVO distal to the A1 segment between January 2013 and October 2021 were analyzed and compared by one-to-one propensity score matching (PSM). Early outcome was measured by the median improvement of National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours. Favorable functional outcome was defined as modified Rankin scale scores of 0-2 at 90 days. Safety was assessed by the occurrence of symptomatic intracerebral hemorrhage and mortality. Results Of 154 patients (median age, 77 years; quartile 1 [Q1] to quartile 3 [Q3], 66-84 years; 80 men; 94 patients with MT; 60 patients with BMT) who met the inclusion criteria, 110 patients (median age, 76 years; Q1-Q3, 67-83 years; 50 men; 55 patients with MT; 55 patients with BMT) were matched. DMVOs were in A2 (82 patients; 53%), A3 (69 patients; 45%), and A3 (three patients; 2%). After PSM, the median 24-hour NIHSS point decrease was -2 (Q1-Q3, -4 to 0) in the thrombectomy and -1 (Q1-Q3, -4 to 1.25) in the BMT cohort (P = .52). Favorable functional outcome (MT vs BMT, 18 of 37 [49%] vs 19 of 39 [49%], respectively; P = .99) and mortality (MT vs BMT, eight of 37 [22%] vs 12 of 39 [31%], respectively; P = .36) were similar in both groups. Symptomatic intracranial hemorrhage occurred in three (2%) of 154 patients. Conclusion Thrombectomy appears to be a safe and technically feasible treatment option for primary isolated anterior cerebral artery occlusions in the A2 and A3 segment with clinical outcomes similar to best medical treatment with and without intravenous thrombolysis. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zhu and Wang in this issue.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / Infarto da Artéria Cerebral Anterior Idioma: En Ano de publicação: 2023 Tipo de documento: Article
Texto completo
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PubMed Links
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / Infarto da Artéria Cerebral Anterior Idioma: En Ano de publicação: 2023 Tipo de documento: Article