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Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study.
Salim, Hamza Adel; Yedavalli, Vivek; Musmar, Basel; Adeeb, Nimer; E L Naamani, Kareem; Henninger, Nils; Sundararajan, Sri Hari; Kühn, Anna Luisa; Khalife, Jane; Ghozy, Sherief; Scarcia, Luca; Tan, Benjamin Yong Qiang; Heit, Jeremy J; Regenhardt, Robert W; Cancelliere, Nicole M; Bernstock, Joshua D; Rouchaud, Aymeric; Fiehler, Jens; Essibayi, Muhammed Amir; Sheth, Sunil A; Puri, Ajit S; Barreau, Xavier; Colasurdo, Marco; Renieri, Leonardo; Dyzmann, Christian; Marotta, Thomas; Spears, Julian; Mowla, Askan; Jabbour, Pascal; Filipe, João Pedro; Biswas, Arundhati; Harker, Pablo; Clarençon, Frédéric; Radu, Razvan Alexandru; Siegler, James E; Nguyen, Thanh N; Varela, Ricardo; Ota, Takahiro; Gonzalez, Nestor; Moehlenbruch, Markus A; Altschul, David; Gory, Benjamin; Costalat, Vincent; Stracke, Christian Paul; Aziz-Sultan, Mohammad Ali; Hecker, Constantin; Shaikh, Hamza; Liebeskind, David S; Baker, Amanda; Pedicelli, Alessandro.
Afiliação
  • Salim HA; Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA Hamza.sleeem@gmail.com admytriw@mgh.harvard.edu vyedava1@jhmi.edu.
  • Yedavalli V; Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Musmar B; Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
  • Adeeb N; Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA Hamza.sleeem@gmail.com admytriw@mgh.harvard.edu vyedava1@jhmi.edu.
  • E L Naamani K; Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
  • Henninger N; Neurosurgery, BIDMC, Shreveport, Louisiana, USA.
  • Sundararajan SH; Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
  • Kühn AL; Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
  • Khalife J; New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
  • Ghozy S; Mass General Brigham Inc, Boston, Massachusetts, USA.
  • Scarcia L; Cooper Hospital University Medical Center, Camden, New Jersey, USA.
  • Tan BYQ; Radiology Neuroradiology Department, Mayo Clinic, Rochester, Minnesota, USA.
  • Heit JJ; Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy.
  • Regenhardt RW; Internal Medicine, NUHS, Singapore.
  • Cancelliere NM; Stanford Medicine, Stanford, California, USA.
  • Bernstock JD; Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston MA, Boston, Massachusetts, USA.
  • Rouchaud A; Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada.
  • Fiehler J; Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Essibayi MA; Interventional Neuroradiology, Hopital Bicetre, Paris Kremlin Bicêtre, France.
  • Sheth SA; Radiology, Mayo Clinic, Rochester, Minnesota, USA.
  • Puri AS; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
  • Barreau X; Montefiore Medical Center, New York, New York, USA.
  • Colasurdo M; Neurology, University of Texas - Houston, Houston, Texas, USA.
  • Renieri L; Radiology and Neurosurgery, Univ Massachusetts, Worcester, Massachusetts, USA.
  • Dyzmann C; Neuroradiology, CHU de Bordeaux, Bordeaux, France.
  • Marotta T; Oregon Health & Science University, Portland, Oregon, USA.
  • Spears J; Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.
  • Mowla A; Sana Kliniken AG, Ismaning, Bayern, Germany.
  • Jabbour P; University of Toronto, Toronto, Ontario, Canada.
  • Filipe JP; Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Pessac, France.
  • Biswas A; Department of Surgery, Division of Neurosurgery, University of Toronto, Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
  • Harker P; USC Keck School of Medicine, Los Angeles, California, USA.
  • Clarençon F; Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
  • Radu RA; Centro Hospitalar Universitário do Porto EPE, Porto, Portugal.
  • Siegler JE; Neurosurgery, Albert Einstein College of Medicine, Bronx, New York, USA.
  • Nguyen TN; University of Cincinnati, Cincinnati, Ohio, USA.
  • Varela R; Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France.
  • Ota T; Hospital Gui de Chauliac Head and Neck Neuroscience Unit, Montpellier, France.
  • Gonzalez N; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Moehlenbruch MA; Neurology, Neurosurgery, Radiology, Boston University Medical Center, Boston, Massachusetts, USA.
  • Altschul D; Neurology, University of California, Los Angeles, Los Angeles, California, USA.
  • Gory B; Radiological Sciences, Catholic University of Sacred Heart, "A. Gemelli" Hospital, Rome, Italy.
  • Costalat V; Radiology and Neuroradiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Stracke CP; University of Münster, Munster, Germany.
  • Aziz-Sultan MA; Montefiore Medical Center, New York, New York, USA.
  • Hecker C; Hôpital Civil Marie Curie à Lodelinsart, Charleroi, Belgium.
  • Shaikh H; Neuroradiology, Henri Mondor Hospital, Créteil, France.
  • Liebeskind DS; Centre Universitair Bruxelles Hôpital Erasme, Bruxelles, Belgium.
  • Baker A; Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Pedicelli A; Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria.
J Neurol Neurosurg Psychiatry ; 2024 Jul 23.
Article em En | MEDLINE | ID: mdl-39043567
ABSTRACT

BACKGROUND:

The efficacy of endovascular treatment (EVT) in acute ischaemic stroke due to distal medium vessel occlusion (DMVO) remains uncertain. Our study aimed to evaluate the safety and efficacy of EVT compared with the best medical management (BMM) in DMVO.

METHODS:

In this prospectively collected, retrospectively reviewed, multicentre cohort study, we analysed data from the Multicentre Analysis of primary Distal medium vessel occlusions effect of Mechanical Thrombectomy registry. Patients with acute ischaemic stroke due to DMVO in the M2, M3 and M4 segments who underwent EVT or received BMM were included. Primary outcome measures comprised 10 co-primary endpoints, including functional independence (mRS 0-2), excellent outcome (mRS 0-1), mortality (mRS 6) and haemorrhagic complications. Propensity score matching was employed to balance the cohorts.

RESULTS:

Among 2125 patients included in the primary analysis, 1713 received EVT and 412 received BMM. After propensity score matching, each group comprised 391 patients. At 90 days, no significant difference was observed in achieving mRS 0-2 between EVT and BMM (adjusted OR 1.00, 95% CI 0.67 to 1.50, p>0.99). However, EVT was associated with higher rates of symptomatic intracerebral haemorrhage (8.4% vs 3.0%, adjusted OR 3.56, 95% CI 1.69 to 7.48, p<0.001) and any intracranial haemorrhage (37% vs 19%, adjusted OR 2.61, 95% CI 1.81 to 3.78, p<0.001). Mortality rates were similar between groups (13% in both, adjusted OR 1.48, 95% CI 0.87 to 2.51, p=0.15).

CONCLUSION:

Our findings suggest that while EVT does not significantly improve functional outcomes compared with BMM in DMVO, it is associated with higher risks of haemorrhagic complications. These results support a cautious approach to the use of EVT in DMVO and highlight the need for further prospective randomised trials to refine treatment strategies.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article
Texto completo
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XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article