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

IF 6 1区 医学 Q1 CLINICAL NEUROLOGY
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,
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引用次数: 0

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.
机械取栓术与静脉溶栓治疗远端中血管急性缺血性卒中:一项跨国多中心倾向评分匹配研究。
背景和目的对远端中血管闭塞(DMVO)引起的急性缺血性卒中(AIS)的处理仍不确定,尤其是在比较静脉溶栓(IVT)加机械取栓(MT)与单纯 IVT 的有效性方面。这项研究旨在评估接受 MT-IVT 或单独 IVT 治疗的 DMVO 患者的安全性和有效性。研究纳入了因DMVO导致的AIS患者,数据收集时间为2017年9月至2023年7月。主要结果是功能独立性,次要结果包括死亡率和脑出血类型等安全性指标。90天后的功能结果显示,两组患者在实现良好功能恢复(改良Rankin量表0-1和0-2)方面无显著差异,调整后的几率比(OR)分别为1.21(95% 置信区间[CI] 0.81至1.79;P=0.35)和1.00(95% CI 0.66至1.51;P>0.99)。两组 90 天的死亡率相似(OR 0.75,95% CI 0.44 至 1.29;P=0.30)。无症状性脑出血的发生率相当,但任何类型的颅内出血在MT-IVT组明显较高(OR为0.43,95% CI为0.29至0.63;P<0.001)。结论本研究结果表明,虽然 MT-IVT 和单纯 IVT 在 DMVO 患者中显示出相似的功能和死亡率结果,但 MT-IVT 出血性并发症的风险更高,因此 MT-IVT 不一定能为所有 DMVO 卒中患者带来比单纯 IVT 更多的获益。需要进一步开展前瞻性随机试验,以确定 DMVO 患者中最有可能从 MT-IVT 治疗中获益的患者亚群。
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来源期刊
Journal of Stroke
Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE
CiteScore
11.00
自引率
3.70%
发文量
52
审稿时长
12 weeks
期刊介绍: The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.
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