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Endovascular Thrombectomy Versus Medical Management in Isolated M2 Occlusions: Pooled Patient-Level Analysis from the EXTEND-IA Trials, INSPIRE, and SELECT Studies.
Sarraj, Amrou; Parsons, Mark; Bivard, Andrew; Hassan, Ameer E; Abraham, Michael G; Wu, Teddy; Kleinig, Timothy; Lin, Longting; Chen, Chushuang; Levi, Christopher; Dong, Qiang; Cheng, Xin; Butcher, Ken S; Choi, Philip; Yassi, Nawaf; Shah, Darshan; Sharma, Gagan; Pujara, Deep; Shaker, Faris; Blackburn, Spiros; Dewey, Helen; Thijs, Vincent; Sitton, Clark W; Donnan, Geoffrey A; Mitchell, Peter J; Yan, Bernard; Grotta, James G; Albers, Gregory W; Davis, Stephen M; Campbell, Bruce.
Afiliación
  • Sarraj A; Case Western Reserve University, Neurology, Cleveland, OH, USA.
  • Parsons M; University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
  • Bivard A; The University of New South Wales, Neurology, Sydney, New South Wales, Australia.
  • Hassan AE; The Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Neurology, Parkville, Victoria, Australia.
  • Abraham MG; The University of Newcastle, Stroke and Brain Injury Center, Callaghan, New South Wales, Australia.
  • Wu T; University of Texas Rio Grande Valley - Valley Baptist Medical Center, Neurology, Harlingen, TX, USA.
  • Kleinig T; University of Kansas Medical Center, Kansas City, KS, USA.
  • Lin L; Christchurch Hospital, Neurology, Christchurch, New Zealand.
  • Chen C; Royal Adelaide Hospital, Neurology, Adelaide, South Australia, Australia.
  • Levi C; John Hunter Hospital, University of Newcastle, Neurology, Newcastle, New South Wales, Australia.
  • Dong Q; John Hunter Hospital, University of Newcastle, Neurology, Newcastle, New South Wales, Australia.
  • Cheng X; John Hunter Hospital, University of Newcastle, Neurology, Newcastle, New South Wales, Australia.
  • Butcher KS; Huashan Hospital, Fudan University, Neurology, Shanghai, China.
  • Choi P; Huashan Hospital, Fudan University, Neurology, Shanghai, China.
  • Yassi N; The University of New South Wales, Neurology, Sydney, New South Wales, Australia.
  • Shah D; Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
  • Sharma G; The Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Neurology, Parkville, Victoria, Australia.
  • Pujara D; The Walter and Eliza Hall Institute of Medical Research, Population Health and Immunity Division, Parkville, Victoria, Australia.
  • Shaker F; Gold Coast University Hospital, Neurology, Southport, Queensland, Australia.
  • Blackburn S; The Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Neurology, Parkville, Victoria, Australia.
  • Dewey H; University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
  • Thijs V; UTHealth McGovern Medical School, Neurosurgery, Houston, TX, USA.
  • Sitton CW; UTHealth McGovern Medical School, Neurosurgery, Houston, TX, USA.
  • Donnan GA; Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
  • Mitchell PJ; Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
  • Yan B; UTHealth McGovern Medical School, Diagnostic and Interventional Imaging, Houston, TX, USA.
  • Grotta JG; The Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Neurology, Parkville, Victoria, Australia.
  • Albers GW; The Royal Melbourne Hospital, University of Melbourne, Radiology, Parkville, Victoria, Australia.
  • Davis SM; The Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Neurology, Parkville, Victoria, Australia.
  • Campbell B; Memorial Hermann - Texas Medical Center, Neurology, Houston, TX, USA.
Ann Neurol ; 91(5): 629-639, 2022 05.
Article en En | MEDLINE | ID: mdl-35184327
ABSTRACT

OBJECTIVE:

The objective of this study was to evaluate functional and safety outcomes of endovascular thrombectomy (EVT) versus medical management (MM) in patients with M2 occlusion and examine their association with perfusion imaging mismatch and stroke severity.

METHODS:

In a pooled, patient-level analysis of 3 randomized controlled trials (EXTEND-IA, EXTEND-and IA-TNK parts 1 and 2) and 2 prospective nonrandomized studies (INSPIRE and SELECT), we evaluated EVT association with 90-day functional independence (modified Rankin Scale [mRS] = 0-2) in isolated M2 occlusions as compared to medical management overall and in subgroups by mismatch profile status and stroke severity.

RESULTS:

We included 517 patients (EVT = 195 and MM = 322), baseline median (interquartile range [IQR]) National Institutes of Health Stroke Scale (NIHSS) was 13 (8-19) in EVT versus 10 (6-15) in MM, p < 0.001. Pretreatment ischemic core did not differ (EVT = 10 [0-24] ml vs MM = 9 [3-21] ml, p = 0.59). Compared to MM, EVT was more frequently associated with functional independence (68.3 vs 61.6%, adjusted odds ratio [aOR] = 2.42, 95% confidence interval [CI] = 1.25-4.67, p = 0.008, inverse probability of treatment weights [IPTW]-OR = 1.75, 95% CI = 1.00-3.75, p = 0.05) with a shift toward better mRS outcomes (adjusted cOR = 2.02, 95% CI1.23-3.29, p = 0.005), and lower mortality (5 vs 10%, aOR = 0.32, 95% CI = 0.12-0.87, p = 0.025). EVT was associated with higher functional independence in patients with a perfusion mismatch profile (EVT = 70.7% vs MM = 61.3%, aOR = 2.29, 95% CI = 1.09-4.79, p = 0.029, IPTW-OR = 2.02, 1.08-3.78, p = 0.029), whereas no difference was found in those without mismatch (EVT = 43.8% vs MM = 62.7%, p = 0.17, IPTW-OR 0.71, 95% CI = 0.18-2.78, p = 0.62). Functional independence was more frequent with EVT in patients with moderate or severe strokes, as defined by baseline NIHSS above any thresholds from 6 to 10, whereas there was no difference between groups with milder strokes below these thresholds.

INTERPRETATION:

In patients with M2 occlusion, EVT was associated with improved clinical outcomes when compared to MM. This association was primarily observed in patients with a mismatch profile and those with higher stroke severity. ANN NEUROL 2022;91629-639.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares Tipo de estudio: Clinical_trials / Observational_studies Límite: Humans Idioma: En Revista: Ann Neurol Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares Tipo de estudio: Clinical_trials / Observational_studies Límite: Humans Idioma: En Revista: Ann Neurol Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos