Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study

Hamza Adel Salim; Vivek Yedavalli; Basel Musmar; Nimer Adeeb; Kareem E.L. Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kühn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Benjamin Yong Qiang Tan; Jeremy J. Heit; Robert W. Regenhardt; Nicole M. Cancelliere; Joshua D. Bernstock; Aymeric Rouchaud; Jens Fiehler; Muhammed Amir Essibayi; Sunil A. Sheth; Ajit S. Puri; Xavier Barreau; Marco Colasurdo; Leonardo Renieri; Christian Dyzmann; Thomas Marotta; Julian Spears; Askan Mowla; Pascal Jabbour; João Pedro Filipe; Arundhati Biswas; Pablo Harker; Frédéric Clarençon; RÄazvan Alexandru Radu; James E. Siegler; Thanh N. Nguyen; Ricardo Varela; Takahiro Ota; Nestor Gonzalez; Markus A. Moehlenbruch; David Altschul; Benjamin Gory; Vincent Costalat; Christian Paul Stracke; Mohammad Ali Aziz-Sultan; Constantin Hecker; Hamza Shaikh; David S. Liebeskind; Amanda Baker; Alessandro Pedicelli; Andrea Alexandre; Tobias D. Faizy; Illario Tancredi; Erwah Kalsoum; Boris Lubicz; Aman B. Patel; Vitor Mendes Pereira; Adrien Guenego; Adam A. Dmytriw; Abdelaziz Amllay; Achala Vagal; Adrien Ter Schiphorst; Ajith J. Thomas; Anil Gopinathan; Anne Dusart; Carolina Capirossi; Charbel Mounayer; Charlotte Weyland; Cheng Yang Hsieh; Christoph J. Griessenauer; Christopher J. Stapleton; Flavio Bellante; Gaultier Marnat; Géraud Forestier; Hugo H. Cuellar-Saenz; Iacopo Valente; Igor Sibon; James D. Rabinov; Jérôme Berge; Jessica Jesser; Juan Carlos Martinez-Gutierrez; Kevin Premat; Leonard L.L. Yeo; Lina Chervak; Lukas Meyer; Mahmoud Elhorany; Miguel Quintero-Consuegra; Mohamad Abdalkader; Monika Killer-Oberpfalzer; Peter T. Kan; Piers Klein; Priyank Khandelwal; Ramanathan Kadirvel; Robert Fahed; Sergio Salazar-Marioni; Shogo Dofuku; Simona Nedelcu; Stavropoula I. Tjoumakaris; Suzana Saleme; Yasmin Aziz

doi:10.1136/jnnp-2024-333669

Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study

Hamza Adel Salim, Vivek Yedavalli, Basel Musmar, Nimer Adeeb, Kareem E.L. Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Benjamin Yong Qiang Tan, Jeremy J. Heit, Robert W. Regenhardt, Nicole M. Cancelliere, Joshua D. Bernstock, Aymeric Rouchaud, Jens Fiehler, Muhammed Amir Essibayi, Sunil A. ShethAjit S. Puri, Xavier Barreau, Marco Colasurdo, Leonardo Renieri, Christian Dyzmann, Thomas Marotta, Julian Spears, Askan Mowla, Pascal Jabbour, João Pedro Filipe, Arundhati Biswas, Pablo Harker, Frédéric Clarençon, RÄazvan Alexandru Radu, James E. Siegler, Thanh N. Nguyen, Ricardo Varela, Takahiro Ota, Nestor Gonzalez, Markus A. Moehlenbruch, David Altschul, Benjamin Gory, Vincent Costalat, Christian Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, David S. Liebeskind, Amanda Baker, Alessandro Pedicelli, Andrea Alexandre, Tobias D. Faizy, Illario Tancredi, Erwah Kalsoum, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Adrien Guenego, Adam A. Dmytriw, Abdelaziz Amllay, Achala Vagal, Adrien Ter Schiphorst, Ajith J. Thomas, Anil Gopinathan, Anne Dusart, Carolina Capirossi, Charbel Mounayer, Charlotte Weyland, Cheng Yang Hsieh, Christoph J. Griessenauer, Christopher J. Stapleton, Flavio Bellante, Gaultier Marnat, Géraud Forestier, Hugo H. Cuellar-Saenz, Iacopo Valente, Igor Sibon, James D. Rabinov, Jérôme Berge, Jessica Jesser, Juan Carlos Martinez-Gutierrez, Kevin Premat, Leonard L.L. Yeo, Lina Chervak, Lukas Meyer, Mahmoud Elhorany, Miguel Quintero-Consuegra, Mohamad Abdalkader, Monika Killer-Oberpfalzer, Peter T. Kan, Piers Klein, Priyank Khandelwal, Ramanathan Kadirvel, Robert Fahed, Sergio Salazar-Marioni, Shogo Dofuku, Simona Nedelcu, Stavropoula I. Tjoumakaris, Suzana Saleme, Yasmin Aziz

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

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: 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: 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: 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.

Original language	English (US)
Journal	Journal of Neurology, Neurosurgery and Psychiatry
DOIs	https://doi.org/10.1136/jnnp-2024-333669
State	Accepted/In press - 2024

Keywords

STROKE

ASJC Scopus subject areas

Surgery
Clinical Neurology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/jnnp-2024-333669

Cite this

Salim, H. A., Yedavalli, V., Musmar, B., Adeeb, N., Naamani, K. E. L., Henninger, N., Sundararajan, S. H., Kühn, A. L., Khalife, J., Ghozy, S., Scarcia, L., Tan, B. Y. Q., Heit, J. J., Regenhardt, R. W., Cancelliere, N. M., Bernstock, J. D., Rouchaud, A., Fiehler, J., Essibayi, M. A., ... Aziz, Y. (Accepted/In press). Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study. Journal of Neurology, Neurosurgery and Psychiatry. https://doi.org/10.1136/jnnp-2024-333669

Salim, HA, Yedavalli, V, Musmar, B, Adeeb, N, Naamani, KEL, Henninger, N, Sundararajan, SH, Kühn, AL, Khalife, J, Ghozy, S, Scarcia, L, Tan, BYQ, Heit, JJ, Regenhardt, RW, Cancelliere, NM, Bernstock, JD, Rouchaud, A, Fiehler, J, Essibayi, MA, Sheth, SA, Puri, AS, Barreau, X, Colasurdo, M, Renieri, L, Dyzmann, C, Marotta, T, Spears, J, Mowla, A, Jabbour, P, Filipe, JP, Biswas, A, Harker, P, Clarençon, F, Radu, RÄA, Siegler, JE, Nguyen, TN, Varela, R, Ota, T, Gonzalez, N, Moehlenbruch, MA, Altschul, D, Gory, B, Costalat, V, Stracke, CP, Aziz-Sultan, MA, Hecker, C, Shaikh, H, Liebeskind, DS, Baker, A, Pedicelli, A, Alexandre, A, Faizy, TD, Tancredi, I, Kalsoum, E, Lubicz, B, Patel, AB, Mendes Pereira, V, Guenego, A, Dmytriw, AA, Amllay, A, Vagal, A, Schiphorst, AT, Thomas, AJ, Gopinathan, A, Dusart, A, Capirossi, C, Mounayer, C, Weyland, C, Hsieh, CY, Griessenauer, CJ, Stapleton, CJ, Bellante, F, Marnat, G, Forestier, G, Cuellar-Saenz, HH, Valente, I, Sibon, I, Rabinov, JD, Berge, J, Jesser, J, Martinez-Gutierrez, JC, Premat, K, Yeo, LLL, Chervak, L, Meyer, L, Elhorany, M, Quintero-Consuegra, M, Abdalkader, M, Killer-Oberpfalzer, M, Kan, PT, Klein, P, Khandelwal, P, Kadirvel, R, Fahed, R, Salazar-Marioni, S, Dofuku, S, Nedelcu, S, Tjoumakaris, SI, Saleme, S & Aziz, Y 2024, 'Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study', Journal of Neurology, Neurosurgery and Psychiatry. https://doi.org/10.1136/jnnp-2024-333669

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title = "Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study",

abstract = "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: 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: 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: 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.",

keywords = "STROKE",

author = "Salim, {Hamza Adel} and Vivek Yedavalli and Basel Musmar and Nimer Adeeb and Naamani, {Kareem E.L.} and Nils Henninger and Sundararajan, {Sri Hari} and K{\"u}hn, {Anna Luisa} and Jane Khalife and Sherief Ghozy and Luca Scarcia and Tan, {Benjamin Yong Qiang} and Heit, {Jeremy J.} and Regenhardt, {Robert W.} and Cancelliere, {Nicole M.} and Bernstock, {Joshua D.} and Aymeric Rouchaud and Jens Fiehler and Essibayi, {Muhammed Amir} and Sheth, {Sunil A.} and Puri, {Ajit S.} and Xavier Barreau and Marco Colasurdo and Leonardo Renieri and Christian Dyzmann and Thomas Marotta and Julian Spears and Askan Mowla and Pascal Jabbour and Filipe, {Jo{\~a}o Pedro} and Arundhati Biswas and Pablo Harker and Fr{\'e}d{\'e}ric Claren{\c c}on and Radu, {R{\"A}azvan Alexandru} and Siegler, {James E.} and Nguyen, {Thanh N.} and Ricardo Varela and Takahiro Ota and Nestor Gonzalez and Moehlenbruch, {Markus A.} and David Altschul and Benjamin Gory and Vincent Costalat and Stracke, {Christian Paul} and Aziz-Sultan, {Mohammad Ali} and Constantin Hecker and Hamza Shaikh and Liebeskind, {David S.} and Amanda Baker and Alessandro Pedicelli and Andrea Alexandre and Faizy, {Tobias D.} and Illario Tancredi and Erwah Kalsoum and Boris Lubicz and Patel, {Aman B.} and {Mendes Pereira}, Vitor and Adrien Guenego and Dmytriw, {Adam A.} and Abdelaziz Amllay and Achala Vagal and Schiphorst, {Adrien Ter} and Thomas, {Ajith J.} and Anil Gopinathan and Anne Dusart and Carolina Capirossi and Charbel Mounayer and Charlotte Weyland and Hsieh, {Cheng Yang} and Griessenauer, {Christoph J.} and Stapleton, {Christopher J.} and Flavio Bellante and Gaultier Marnat and G{\'e}raud Forestier and Cuellar-Saenz, {Hugo H.} and Iacopo Valente and Igor Sibon and Rabinov, {James D.} and J{\'e}r{\^o}me Berge and Jessica Jesser and Martinez-Gutierrez, {Juan Carlos} and Kevin Premat and Yeo, {Leonard L.L.} and Lina Chervak and Lukas Meyer and Mahmoud Elhorany and Miguel Quintero-Consuegra and Mohamad Abdalkader and Monika Killer-Oberpfalzer and Kan, {Peter T.} and Piers Klein and Priyank Khandelwal and Ramanathan Kadirvel and Robert Fahed and Sergio Salazar-Marioni and Shogo Dofuku and Simona Nedelcu and Tjoumakaris, {Stavropoula I.} and Suzana Saleme and Yasmin Aziz",

note = "Publisher Copyright: {\textcopyright} 2024 Author(s).",

year = "2024",

doi = "10.1136/jnnp-2024-333669",

language = "English (US)",

journal = "Journal of Neurology, Neurosurgery and Psychiatry",

issn = "0022-3050",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke

T2 - a multinational multicentre propensity score-matched study

AU - Salim, Hamza Adel

AU - Yedavalli, Vivek

AU - Musmar, Basel

AU - Adeeb, Nimer

AU - Naamani, Kareem E.L.

AU - Henninger, Nils

AU - Sundararajan, Sri Hari

AU - Kühn, Anna Luisa

AU - Khalife, Jane

AU - Ghozy, Sherief

AU - Scarcia, Luca

AU - Tan, Benjamin Yong Qiang

AU - Heit, Jeremy J.

AU - Regenhardt, Robert W.

AU - Cancelliere, Nicole M.

AU - Bernstock, Joshua D.

AU - Rouchaud, Aymeric

AU - Fiehler, Jens

AU - Essibayi, Muhammed Amir

AU - Sheth, Sunil A.

AU - Puri, Ajit S.

AU - Barreau, Xavier

AU - Colasurdo, Marco

AU - Renieri, Leonardo

AU - Dyzmann, Christian

AU - Marotta, Thomas

AU - Spears, Julian

AU - Mowla, Askan

AU - Jabbour, Pascal

AU - Filipe, João Pedro

AU - Biswas, Arundhati

AU - Harker, Pablo

AU - Clarençon, Frédéric

AU - Radu, RÄazvan Alexandru

AU - Siegler, James E.

AU - Nguyen, Thanh N.

AU - Varela, Ricardo

AU - Ota, Takahiro

AU - Gonzalez, Nestor

AU - Moehlenbruch, Markus A.

AU - Altschul, David

AU - Gory, Benjamin

AU - Costalat, Vincent

AU - Stracke, Christian Paul

AU - Aziz-Sultan, Mohammad Ali

AU - Hecker, Constantin

AU - Shaikh, Hamza

AU - Liebeskind, David S.

AU - Baker, Amanda

AU - Pedicelli, Alessandro

AU - Alexandre, Andrea

AU - Faizy, Tobias D.

AU - Tancredi, Illario

AU - Kalsoum, Erwah

AU - Lubicz, Boris

AU - Patel, Aman B.

AU - Mendes Pereira, Vitor

AU - Guenego, Adrien

AU - Dmytriw, Adam A.

AU - Amllay, Abdelaziz

AU - Vagal, Achala

AU - Schiphorst, Adrien Ter

AU - Thomas, Ajith J.

AU - Gopinathan, Anil

AU - Dusart, Anne

AU - Capirossi, Carolina

AU - Mounayer, Charbel

AU - Weyland, Charlotte

AU - Hsieh, Cheng Yang

AU - Griessenauer, Christoph J.

AU - Stapleton, Christopher J.

AU - Bellante, Flavio

AU - Marnat, Gaultier

AU - Forestier, Géraud

AU - Cuellar-Saenz, Hugo H.

AU - Valente, Iacopo

AU - Sibon, Igor

AU - Rabinov, James D.

AU - Berge, Jérôme

AU - Jesser, Jessica

AU - Martinez-Gutierrez, Juan Carlos

AU - Premat, Kevin

AU - Yeo, Leonard L.L.

AU - Chervak, Lina

AU - Meyer, Lukas

AU - Elhorany, Mahmoud

AU - Quintero-Consuegra, Miguel

AU - Abdalkader, Mohamad

AU - Killer-Oberpfalzer, Monika

AU - Kan, Peter T.

AU - Klein, Piers

AU - Khandelwal, Priyank

AU - Kadirvel, Ramanathan

AU - Fahed, Robert

AU - Salazar-Marioni, Sergio

AU - Dofuku, Shogo

AU - Nedelcu, Simona

AU - Tjoumakaris, Stavropoula I.

AU - Saleme, Suzana

AU - Aziz, Yasmin

PY - 2024

Y1 - 2024

N2 - 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: 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: 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: 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.

AB - 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: 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: 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: 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.

KW - STROKE

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UR - http://www.scopus.com/inward/citedby.url?scp=85200357311&partnerID=8YFLogxK

U2 - 10.1136/jnnp-2024-333669

DO - 10.1136/jnnp-2024-333669

M3 - Article

C2 - 39043567

AN - SCOPUS:85200357311

SN - 0022-3050

JO - Journal of Neurology, Neurosurgery and Psychiatry

JF - Journal of Neurology, Neurosurgery and Psychiatry

ER -

Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study

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Keywords

ASJC Scopus subject areas

UN SDGs

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