Multicenter evaluation of mechanical thrombectomy for distal medium vessel occlusions with National Institute of Health Stroke Scale Scores ≥ 6 and ≤ 6.

Endovascular technique Patient outcome Stroke Thrombectomy Thrombolysis

Journal

Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161

Informations de publication

Date de publication:
05 Jul 2024
Historique:
received: 06 01 2024
accepted: 24 06 2024
revised: 21 06 2024
medline: 5 7 2024
pubmed: 5 7 2024
entrez: 5 7 2024
Statut: aheadofprint

Résumé

While mechanical thrombectomy is considered standard of care for large vessel occlusions, scientific evidence to support treatment for distal and medium vessel occlusions remains scarce. To evaluate feasibility, safety, and outcomes in patients with low National Institute of Health Stroke Scale scores undergoing mechanical thrombectomy for treatment of distal medium vessel occlusions. Retrospective data review and analysis of prospectively maintained databases at 41 academic centers in North America, Asia, and Europe between January 2017 and January 2022. Characteristics and outcomes were compared between groups with low stroke scale score (≤ 6) versus and higher stroke scale scores (> 6). Propensity score matching using the optimal pair matching method and 1:1 ratio was performed. Data were collected on a total of 1068 patients. After propensity score matching, there were a total of 676 patients included in the final analysis, with 338 patients in each group. High successful reperfusion rates were seen in both groups, 90.2% in ≤ 6 and 88.7% in the > 6 stroke scale groups. The frequency of excellent and good functional outcome was seen more common in low versus higher stroke scale score patients (64.5% and 81.1% versus 39.3% and 58.6%, respectively). The 90-day mortality rate observed in the ≤ 6 stroke scale group was 5.3% versus 13.3% in the > 6 stroke scale group. Mechanical thrombectomy in distal and medium vessel occlusions, specifically in patients with low stroke scale scores is feasible, though it may not necessarily improve outcomes over IVT.

Sections du résumé

BACKGROUND BACKGROUND
While mechanical thrombectomy is considered standard of care for large vessel occlusions, scientific evidence to support treatment for distal and medium vessel occlusions remains scarce.
PURPOSE OBJECTIVE
To evaluate feasibility, safety, and outcomes in patients with low National Institute of Health Stroke Scale scores undergoing mechanical thrombectomy for treatment of distal medium vessel occlusions.
MATERIALS AND METHODS METHODS
Retrospective data review and analysis of prospectively maintained databases at 41 academic centers in North America, Asia, and Europe between January 2017 and January 2022. Characteristics and outcomes were compared between groups with low stroke scale score (≤ 6) versus and higher stroke scale scores (> 6). Propensity score matching using the optimal pair matching method and 1:1 ratio was performed.
RESULTS RESULTS
Data were collected on a total of 1068 patients. After propensity score matching, there were a total of 676 patients included in the final analysis, with 338 patients in each group. High successful reperfusion rates were seen in both groups, 90.2% in ≤ 6 and 88.7% in the > 6 stroke scale groups. The frequency of excellent and good functional outcome was seen more common in low versus higher stroke scale score patients (64.5% and 81.1% versus 39.3% and 58.6%, respectively). The 90-day mortality rate observed in the ≤ 6 stroke scale group was 5.3% versus 13.3% in the > 6 stroke scale group.
CONCLUSION CONCLUSIONS
Mechanical thrombectomy in distal and medium vessel occlusions, specifically in patients with low stroke scale scores is feasible, though it may not necessarily improve outcomes over IVT.

Identifiants

DOI: 10.1007/s00415-024-12537-4 PMID: 38967650
pubmed: 38967650
doi: 10.1007/s00415-024-12537-4
pii: 10.1007/s00415-024-12537-4
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.

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Auteurs

Anna Luisa Kühn (AL)

Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.

Ajit S Puri (AS)

Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.

Hamza Adel Salim (HA)

Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Los Angeles, USA. Hamza.sleeem@gmail.com.
Brigham and Women's Hospital, Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA. Hamza.sleeem@gmail.com.
Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA. Hamza.sleeem@gmail.com.
ORCID: 0000-0002-5208-8425

Basel Musmar (B)

Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Los Angeles, USA.

Sherief Ghozy (S)

Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.

James Siegler (J)

Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.

Hamza Shaikh (H)

Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.

Jane Khalife (J)

Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.

Mohamad Abdalkader (M)

Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.

Piers Klein (P)

Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.

Thanh N Nguyen (TN)

Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.

Jeremy J Heit (JJ)

Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.

Robert W Regenhardt (RW)

Brigham and Women's Hospital, Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.

Jose Danilo Bengzon Diestro (JDB)

Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.

Nicole M Cancelliere (NM)

Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.

Ahmad Sweid (A)

Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.

Kareem El Naamani (KE)

Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.

Zuha Hasan (Z)

Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.

Anil Gopinathan (A)

Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Abdelaziz Amllay (A)

Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.

Lukas Meyer (L)

Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Anne Dusart (A)

Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.

Flavio Bellante (F)

Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.

Géraud Forestier (G)

Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.

Aymeric Rouchaud (A)

Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.

Suzana Saleme (S)

Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.

Charbel Mounayer (C)

Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.

Jens Fiehler (J)

Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Christian Dyzmann (C)

Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.

Peter T Kan (PT)

Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.

Jasmeet Singh (J)

Brigham and Women's Hospital, Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.

Marco Colasurdo (M)

Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.

Gaultier Marnat (G)

Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.

Jérôme Berge (J)

Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.

Xavier Barreau (X)

Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.

Igor Sibon (I)

Neurology Department, Bordeaux University Hospital, Bordeaux, France.

Simona Nedelcu (S)

Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.

Nils Henninger (N)

Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.

Thomas R Marotta (TR)

Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.

Christopher J Stapleton (CJ)

Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Los Angeles, USA.

James D Rabinov (JD)

Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Los Angeles, USA.

Takahiro Ota (T)

Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.

Shogo Dofuku (S)

Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.

Leonard Ll Yeo (LL)

Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Benjamin Y Q Tan (BYQ)

Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Juan Carlos Martinez-Gutierrez (JC)

Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.

Sergio Salazar-Marioni (S)

Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.

Sunil Sheth (S)

Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy.

Leonardo Renieri (L)

Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy.

Carolina Capirossi (C)

Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy.

Ashkan Mowla (A)

Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), 1200 North State St, Suite 3300, Los Angeles, CA, USA.

Stavropoula I Tjoumakaris (SI)

Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.

Pascal Jabbour (P)

Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.

Priyank Khandelwal (P)

Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.

Arundhati Biswas (A)

Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.

Frédéric Clarençon (F)

Department of Neuroradiology, GRC BioFast, Sorbonne University. Paris VI, Pitié-Salpêtrière Hospital, Paris, France.

Mahmoud Elhorany (M)

Department of Neuroradiology, GRC BioFast, Sorbonne University. Paris VI, Pitié-Salpêtrière Hospital, Paris, France.

Kevin Premat (K)

Department of Neuroradiology, GRC BioFast, Sorbonne University. Paris VI, Pitié-Salpêtrière Hospital, Paris, France.

Iacopo Valente (I)

UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy.

Alessandro Pedicelli (A)

UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy.

João Pedro Filipe (JP)

Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário Do Porto, Porto, Portugal.

Ricardo Varela (R)

Department of Neurology, Centro Hospitalar Universitário Do Porto, Porto, Portugal.

Miguel Quintero-Consuegra (M)

Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Nestor R Gonzalez (NR)

Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Markus A Möhlenbruch (MA)

Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.

Jessica Jesser (J)

Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.

Vincent Costalat (V)

Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.

Adrien Ter Schiphorst (A)

Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.

Vivek Yedavalli (V)

Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.

Pablo Harker (P)

Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.

Lina Chervak (L)

Department of Neurology and Radiology, University of Cincinnati, Cincinnati, OH, USA.

Yasmin Aziz (Y)

Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.

Benjamin Gory (B)

Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.

Christian Paul Stracke (CP)

Department of Radiology, Interventional Neuroradiology Section, University Medical Center, Münster, Germany.

Constantin Hecker (C)

Departments of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.

Monika Killer-Oberpfalzer (M)

Departments of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.

Christoph J Griessenauer (CJ)

Departments of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.

Ajith Thomas (A)

Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.

Cheng-Yang Hsieh (CY)

Neurology Department, Sin-Lau Hospital, Tainan, Taiwan.

David S Liebeskind (DS)

UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA.

Răzvan Alexandru Radu (RA)

Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.

Andrea M Alexandre (AM)

UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy.

Robert Fahed (R)

Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada.

Illario Tancredi (I)

Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada.

Tobias D Faizy (TD)

Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Charlotte Weyland (C)

Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.

Boris Lubicz (B)

Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

Aman B Patel (AB)

Brigham and Women's Hospital, Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.

Vitor Mendes Pereira (VM)

Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.

Adrien Guenego (A)

Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

Adam A Dmytriw (AA)

Brigham and Women's Hospital, Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA. admytriw@mgh.harvard.edu.
Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. admytriw@mgh.harvard.edu.

Classifications MeSH