Citations 2
Predictors and Outcomes of Excellent Recanalization Versus Successful Recanalization After Thrombectomy in Proximal and Distal Medium Vessel Occlusion Strokes: A Multinational Study
Yedavalli, Vivek , Salim, Hamza , Adeeb, Nimer , Naamani, Kareem El, Henninger, Nils , Sundararajan, Sri Hari , Khalife, Jane , Ghozy, Sherief, Heit, Jeremy J. , Regenhardt, Robert W. , Puri, Ajit S., Dyzmann, Christian , Barreau, Xavier , Renieri, Leonardo, Filipe, João Pedro , Abdalkader, Mohamad , Marotta, Thomas R. , Spears, Julian , Biswas, Arundhati , Clarençon, Frédéric , Varela, Ricardo , Baker, Amanda , Altschul, David , Gonzalez, Nestor R. , Möhlenbruch, Markus , Costalat, Vincent , Stracke, Christian Paul , Shaikh, Hamza , Liebeskind, David S., Alexandre, Andrea , Tancredi, Illario , Faizy, Tobias D. , Kalsoum, Erwah , Lubicz, Boris , Patel, Aman B. , Guenego, Adrien , Investigators, the MAD MT, Liebeskind, David S. , Salim, Hamza , Liebeskind, David S. , Heit, Jeremy J , Altschul, David J , Gonzalez, Nestor R , Regenhardt, Robert W , Yedavalli, Vivek S , Henninger, Nils , Alexandre, Andrea M , Varela, Ricardo , Musmar, Basel , Naamani, Kareem El , Kühn, Anna Luisa , Ghozy, Sherief , Scarcia, Luca , Tan, Benjamin Yong‐Qiang , Cancelliere, Nicole M , Bernstock, Joshua D. , Rouchaud, Aymeric , Fiehler, Jens , Sheth, Sunil A , Essibayi, Muhammed Amir , Puri, Ajit S , Colasurdo, Marco , Renieri, Leonardo , Harker, Pablo , Radu, Răzvan Alexandru , Klein, Piers , Ota, Takahiro , Mowla, Ashkan , Jabbour, Pascal , Siegler, James E. , Nguyen, Thanh N. , Gory, Benjamin , Aziz‐Sultan, Mohammad Ali , Hecker, Constantin , Pedicelli, Alessandro , Mendes Pereira, Vitor , Dmytriw, Adam A. , Investigators, the MAD MT
Stroke: Vascular and Interventional Neurology | October 26, 2024 | Volume: 4 | Issue: 6 | Pages: No page available
Background Acute ischemic stroke arising from medium vessel occlusions (MeVO) poses substantial challenges in treatment and management. This study aims to elucidate the outcomes and factors contributing to achieving excellent recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2c–3) versus successful recanalization (mTICI 2b) in patients with MeVO stroke undergoing mechanical thrombectomy (MT). Methods We conducted a multinational study analyzing data from the MAD‐MT (Multicenter Analysis of Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy) registry, encompassing 37 centers across North America, Asia, and Europe, collected between September 2017 and July 2023. The study included acute ischemic stroke patients with MeVO treated with MT, with or without intravenous thrombolysis, who achieved mTICI 2b–3 post‐MT. Results Among 1463 patients with successful recanalization (mTICI 2b–3), 523 achieved mTICI 2b recanalization, and 940 achieved mTICI 2c–3. Distal occlusions exhibited higher odds of excellent recanalization compared with proximal MeVO vessel occlusions (odds ratio, 1.58; 95% CI, 1.17–2.15; P = 0.003). Cardioembolic stroke pathogenesis was associated with a higher likelihood of excellent recanalization (1.67; 95% CI, 1.07–2.59; P = 0.018). Patients achieving mTICI 2c–3 recanalization demonstrated lower initial National Institutes of Health Stroke Scale scores, significant improvements in postprocedural National Institutes of Health Stroke Scale shift, and a higher percentage of favorable 90‐day outcomes compared with those with mTICI 2b. However, no significant difference in 90‐day mortality rates was observed. Conclusion This study underscores that among patients with MeVO stroke with successful recanalization (mTICI 2b–3) there is higher likelihood of achieving excellent recanalization (mTICI 2c–3) in distal occlusions and cardioembolic pathogenesis. mTICI 2c–3 scores post‐MT correlate with improved clinical outcomes compared with mTICI 2b, affirming the superiority of excellent recanalization over successful recanalization in patients with MeVO stroke. Further prospective studies and randomized controlled trials are warranted for validation.
Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy
Yedavalli, Vivek , Salim, Hamza , Adeeb, Nimer , Naamani, Kareem El, Henninger, Nils , Sundararajan, Sri Hari , Kühn, Anna Luisa, Khalife, Jane, Ghozy, Sherief, Tan, Benjamin Yong‐Qiang , Heit, Jeremy J. , Regenhardt, Robert W. , Cancelliere, Nicole M , Rouchaud, Aymeric , Sheth, Sunil, Essibayi, Muhammed Amir , Puri, Ajit S , Dyzmann, Christian , Colasurdo, Marco , Barreau, Xavier , Filipe, João Pedro , Marotta, Thomas R. , Spears, Julian , Biswas, Arundhati , Clarençon, Frédéric , Varela, Ricardo , Baker, Amanda , Altschul, David , Gonzalez, Nestor R. , Möhlenbruch, Markus , Costalat, Vincent , Stracke, Christian Paul , Shaikh, Hamza , Liebeskind, David S., Alexandre, Andrea , Tancredi, Illario , Faizy, Tobias D. , Kalsoum, Erwah , Lubicz, Boris , Patel, Aman B. , Guenego, Adrien , Liebeskind, David S. , Henninger, Nils , Tan, Benjamin Yq , Cancelliere, Nicole M , Alexandru Radu, Răzvan , Ota, Takahiro , Jabbour, Pascal , Clarençon, Frédéric , Siegler, James E , Nguyen, Thanh N , Gonzalez, Nestor R , Pedicelli, Alessandro , Alexandre, Andrea M , Guenego, Adrien , Dmytriw, Adam A , Liebeskind, David S. , Heit, Jeremy J , Altschul, David J , Salim, Hamza , Regenhardt, Robert W , Essibayi, Muhammed Amir , Yedavalli, Vivek S , Rouchaud, Aymeric , Colasurdo, Marco , Varela, Ricardo , Musmar, Basel , Naamani, Kareem El , Kühn, Anna Luisa , Khalife, Jane , Ghozy, Sherief , Scarcia, Luca , Bernstock, Joshua D. , Fiehler, Jens , Sheth, Sunil A , Renieri, Leonardo , Harker, Pablo , Radu, Răzvan Alexandru , Mowla, Ashkan , Jabbour, Pascal , Siegler, James E. , Nguyen, Thanh N. , Gory, Benjamin , Aziz‐Sultan, Mohammad Ali , Hecker, Constantin , Mendes Pereira, Vitor , Dmytriw, Adam A.
International Journal of Stroke | July 30, 2024 | Volume: 19 | Issue: 10 | Pages: 1123-1133
Background: Acute ischemic stroke (AIS) from primary medium vessel occlusions (MeVO) is a prevalent condition associated with substantial morbidity and mortality. Despite the common use of mechanical thrombectomy (MT) in AIS, predictors of poor outcomes in MeVO remain poorly characterized. Methods: In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed. The study included 1568 patients from 37 academic centers across North America, Asia, and Europe, treated with MT, with or without intravenous tissue plasminogen activator (IVtPA), between September 2017 and July 2021. Results: Among the 1568 patients, 347 (22.2%) experienced very poor outcomes (modified Rankin score (mRS), 5–6). Key predictors of poor outcomes were advanced age (odds ratio (OR): 1.03; 95% confidence interval (CI): 1.02 to 1.04; p < 0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR: 1.07; 95% CI: 1.05 to 1.10; p < 0.001), pre-operative glucose levels (OR: 1.01; 95% CI: 1.00 to 1.02; p < 0.001), and a baseline mRS of 4 (OR: 2.69; 95% CI: 1.25 to 5.82; p = 0.011). The multivariable model demonstrated good predictive accuracy with an area under the receiver-operating characteristic (ROC) curve of 0.76. Conclusions: This study demonstrates that advanced age, higher NIHSS scores, elevated pre-stroke mRS, and pre-operative glucose levels significantly predict very poor outcomes in AIS-MeVO patients who received MT. These findings highlight the importance of a comprehensive risk assessment in primary MeVO patients for personalized treatment strategies. However, they also suggest a need for cautious patient selection for endovascular thrombectomy. Further prospective studies are needed to confirm these findings and explore targeted therapeutic interventions.