Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study.
STROKE
Journal
Journal of neurology, neurosurgery, and psychiatry
ISSN: 1468-330X
Titre abrégé: J Neurol Neurosurg Psychiatry
Pays: England
ID NLM: 2985191R
Informations de publication
Date de publication:
23 Jul 2024
23 Jul 2024
Historique:
received:
22
02
2024
accepted:
24
06
2024
medline:
24
7
2024
pubmed:
24
7
2024
entrez:
23
7
2024
Statut:
aheadofprint
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 39043567
pii: jnnp-2024-333669
doi: 10.1136/jnnp-2024-333669
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Abdelaziz Amllay
(A)
Achala Vagal
(A)
Adrien Ter Schiphorst
(AT)
Ajith J Thomas
(AJ)
Anil Gopinathan
(A)
Anne Dusart
(A)
Carolina Capirossi
(C)
Charbel Mounayer
(C)
Charlotte Weyland
(C)
Cheng-Yang Hsieh
(CY)
Christoph J Griessenauer
(CJ)
Christopher J Stapleton
(CJ)
Erwah Kalsoum
(E)
Flavio Bellante
(F)
Gaultier Marnat
(G)
Géraud Forestier
(G)
Hamza Shaikh
(H)
Hugo H Cuellar-Saenz
(HH)
Iacopo Valente
(I)
Igor Sibon
(I)
James D Rabinov
(JD)
Jérôme Berge
(J)
Jessica Jesser
(J)
Juan Carlos Martinez-Gutierrez
(JC)
Kevin Premat
(K)
Leonard Ll Yeo
(LL)
Lina Chervak
(L)
Lukas Meyer
(L)
Mahmoud Elhorany
(M)
Miguel Quintero-Consuegra
(M)
Mohamad Abdalkader
(M)
Mohammad Ali Aziz-Sultan
(MA)
Monika Killer-Oberpfalzer
(M)
Peter T Kan
(PT)
Piers Klein
(P)
Priyank Khandelwal
(P)
Ramanathan Kadirvel
(R)
Robert Fahed
(R)
Sergio Salazar-Marioni
(S)
Shogo Dofuku
(S)
Simona Nedelcu
(S)
Stavropoula I Tjoumakaris
(SI)
Suzana Saleme
(S)
Yasmin Aziz
(Y)
Informations de copyright
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.