Journal of Stroke (Sep 2024)
Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study
- Hamza Adel Salim,
- Vivek Yedavalli,
- Basel Musmar,
- Nimer Adeeb,
- Muhammed Amir Essibayi,
- Kareem El Naamani,
- Nils Henninger,
- Sri Hari Sundararajan,
- Anna Luisa Kühn,
- Jane Khalife,
- Sherief Ghozy,
- Luca Scarcia,
- Benjamin Y.Q. Tan,
- Benjamin Pulli,
- Jeremy J. Heit,
- Robert W. Regenhardt,
- Nicole M. Cancelliere,
- Joshua D. Bernstock,
- Aymeric Rouchaud,
- Jens Fiehler,
- Sunil Sheth,
- Ajit S. Puri,
- Christian Dyzmann,
- Marco Colasurdo,
- Xavier Barreau,
- Leonardo Renieri,
- João Pedro Filipe,
- Pablo Harker,
- Razvan Alexandru Radu,
- Thomas R. Marotta,
- Julian Spears,
- Takahiro Ota,
- Ashkan Mowla,
- Pascal Jabbour,
- Arundhati Biswas,
- Frédéric Clarençon,
- James E. Siegler,
- Thanh N. Nguyen,
- Ricardo Varela,
- Amanda Baker,
- David Altschul,
- Nestor R. Gonzalez,
- Markus A. Möhlenbruch,
- Vincent Costalat,
- Benjamin Gory,
- Christian Paul Stracke,
- Mohammad Ali Aziz-Sultan,
- Constantin Hecker,
- Hamza Shaikh,
- David S. Liebeskind,
- Alessandro Pedicelli,
- Andrea M. Alexandre,
- Illario Tancredi,
- Tobias D. Faizy,
- Erwah Kalsoum,
- Boris Lubicz,
- Aman B. Patel,
- Vitor Mendes Pereira,
- Adrien Guenego,
- Adam A. Dmytriw,
Affiliations
- Hamza Adel Salim
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
- Vivek Yedavalli
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
- Basel Musmar
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA
- Nimer Adeeb
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA
- Muhammed Amir Essibayi
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
- Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Sri Hari Sundararajan
- Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA
- Anna Luisa Kühn
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
- Jane Khalife
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
- Sherief Ghozy
- Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA
- Luca Scarcia
- Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
- Benjamin Y.Q. Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Benjamin Pulli
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
- Jeremy J. Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
- Robert W. Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Nicole M. Cancelliere
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
- Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Aymeric Rouchaud
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, Limoges, France
- Jens Fiehler
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
- Sunil Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA
- Ajit S. Puri
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
- Christian Dyzmann
- Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany
- Marco Colasurdo
- Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
- Xavier Barreau
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
- Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
- João Pedro Filipe
- Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Pablo Harker
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
- Razvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Thomas R. Marotta
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
- Julian Spears
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
- Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
- Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
- Arundhati Biswas
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
- Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; GRC BioFast, Sorbonne University, Paris VI, Paris, France
- James E. Siegler
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
- Thanh N. Nguyen
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
- Ricardo Varela
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Amanda Baker
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- David Altschul
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Nestor R. Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Markus A. Möhlenbruch
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
- Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Benjamin Gory
- Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France
- Christian Paul Stracke
- Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany
- Mohammad Ali Aziz-Sultan
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Constantin Hecker
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
- Hamza Shaikh
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
- David S. Liebeskind
- UCLA Stroke Center and Department of Neurology Department, University of California, Los Angeles, Los Angeles, CA, USA
- Alessandro Pedicelli
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Roma, Italy
- Andrea M. Alexandre
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Roma, Italy
- Illario Tancredi
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
- Tobias D. Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Erwah Kalsoum
- Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
- Boris Lubicz
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
- Aman B. Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Vitor Mendes Pereira
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
- Adrien Guenego
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
- Adam A. Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- DOI
- https://doi.org/10.5853/jos.2024.01389
- Journal volume & issue
-
Vol. 26,
no. 3
pp. 434 – 445
Abstract
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.
Keywords
