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

Autor:	Salim HA; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.; Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA., Yedavalli V; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA., Musmar B; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA., Adeeb N; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA., Essibayi MA; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA., Naamani KE; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA., Henninger N; Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Sundararajan SH; Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA., Kühn AL; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA., Khalife J; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA., Ghozy S; Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA., Scarcia L; Department of Neuroradiology, Henri Mondor Hospital, Creteil, France., Tan BYQ; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, Singapore., Pulli B; Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA., Heit JJ; Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA., Regenhardt RW; Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA., Cancelliere NM; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada., Bernstock JD; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Rouchaud A; University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, Limoges, France., Fiehler J; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Sheth S; Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA., Puri AS; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA., Dyzmann C; Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany., Colasurdo M; Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA., Barreau X; Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France., Renieri L; Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy., Filipe JP; Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal., Harker P; Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA., Radu RA; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France., Marotta TR; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada., Spears J; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada., Ota T; Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan., Mowla A; Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA., Jabbour P; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA., Biswas A; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA., Clarençon F; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; GRC BioFast, Sorbonne University, Paris VI, Paris, France., Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA., Nguyen TN; Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA., Varela R; Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal., Baker A; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA., Altschul D; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA., Gonzalez NR; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Möhlenbruch MA; Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany., Costalat V; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France., Gory B; Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.; INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France., Stracke CP; Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany., Aziz-Sultan MA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Hecker C; Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria., Shaikh H; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA., Liebeskind DS; UCLA Stroke Center and Department of Neurology Department, University of California, Los Angeles, Los Angeles, CA, USA., Pedicelli A; UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Roma, Italy., Alexandre AM; UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Roma, Italy., Tancredi I; Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium., Faizy TD; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Kalsoum E; Department of Neuroradiology, Henri Mondor Hospital, Creteil, France., Lubicz B; Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium., Patel AB; Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA., Pereira VM; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada., Guenego A; Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium., Dmytriw AA; Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
Jazyk:	angličtina
Zdroj:	Journal of stroke [J Stroke] 2024 Sep; Vol. 26 (3), pp. 434-445. Date of Electronic Publication: 2024 Sep 13.
DOI:	10.5853/jos.2024.01389
Abstrakt:	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.
Databáze:	MEDLINE
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