Mowla, Ashkan
Mayo Clinic
Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
Citations 2
Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions
Chafai, Imene , Salim, Hamza , Musmar, Basel , Adeeb, Nimer , Yedavalli, Vivek , Tjoumakaris, Stavropoula , Henninger, Nils , Nedelcu, Simona , Sundararajan, Sri Hari , Kühn, Anna Luisa , Khalife, Jane , Tan, Benjamin Yong‐Qiang , Heit, Jeremy J. , Regenhardt, Robert W. , Puri, Ajit S , Dyzmann, Christian , 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 , Patel, Aman B. , Wang, Maud , Lubicz, Boris , Guenego, Adrien , ##, On behalf of the MAD MT Investigators, Tjoumakaris, Stavropoula , Ghozy, Sherief , Scarcia, Luca , Tan, Benjamin Yq , Heit, Jeremy J , Regenhardt, Robert W , Cancelliere, Nicole M , Bernstock, Joshua D , Rouchaud, Aymeric , Fiehler, Jens , Sheth, Sunil A , Essibayi, Muhammed Amir , Colasurdo, Marco , Marnat, Gaultier , Renieri, Leonardo , Filipe, João Pedro , Harker, Pablo , Alexandru Radu, Răzvan , Marotta, Thomas R , Spears, Julian , Ota, Takahiro , Mowla, Ashkan , Jabbour, Pascal , Clarençon, Frédéric , Nguyen, Thanh N , Varela, Ricardo , Altschul, David J , Gonzalez, Nestor R , Möhlenbruch, Markus A , Gory, Benjamin , Stracke, Paul , Hecker, Constantin , Shaikh, Hamza A , Liebeskind, David S. , Pedicelli, Alessandro , Alexandre, Andrea M , Tancredi, Illario , Faizy, Tobias D , Kalsoum, Erwah , Fahed, Robert , Wang, Maud , Mendes Pereira, Vitor , Lubicz, Boris , Dmytriw, Adam A , Guenego, Adrien , Kühn, Anna Luisa , Musmar, Basel , Salim, Hamza , Yedavalli, Vivek S , Henninger, Nils , Nedelcu, Simona , Ghozy, Sherief , Cancelliere, Nicole M , Bernstock, Joshua D. , Rouchaud, Aymeric , Fiehler, Jens , Essibayi, Muhammed Amir , Colasurdo, Marco , Renieri, Leonardo , Harker, Pablo , Radu, Răzvan Alexandru , Mowla, Ashkan , Jabbour, Pascal , Nguyen, Thanh N. , Baker, Amanda, Aziz‐Sultan, Mohammad Ali , Hecker, Constantin , Fahed, Robert , Dmytriw, Adam A. , ##, On behalf of the MAD MT Investigators
Interventional Neuroradiology | July 16, 2025 | Volume: No volume available | Issue: No issue available | Pages: No page available
Objective Mechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still experience poor long-term clinical outcomes, prompting our study to comprehensively explore pre-MT factors influencing outcome despite excellent recanalization (final modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2c). Methods We retrospectively examined data from patients who consecutively underwent MT for a primary middle cerebral artery (MCA) DMVO across 37 centers in North America, Asia, and Europe. We identified baseline clinical and imaging factors associated with poor clinical outcome (defined as a modified Rankin Scale [mRS] score of 3–6) at 3 months, despite excellent recanalization using a multivariable model. Results Between September 2017 and July 2021, 623 patients achieved mTICI > 2b and they were included in our study. Among them, 198 (32%) experienced a poor clinical outcome (mRS 3–6). Predictors of poor clinical outcome included higher age (OR 1.05 [1.03–1.07], p < 0.001), higher NIHSS at admission (OR 1.12 [1.08–1.15], p < 0.001), higher baseline mRS (OR 1.77 [0.96–3.26], p = 0.067), and diabetes (OR 1.59 [1.01–2.48], p = 0.044). Higher ASPECTS was associated with a decreased risk of poor clinical outcome (OR 0.82 [0.71–0.94], p = 0.006). Conclusion Older age, diabetes, higher baseline mRS, and NIHSS were associated with poor clinical outcome in MCA DMVO despite excellent recanalization. Conversely, a higher ASPECTS decreased the probability of such an outcome.
First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study
Radu, Răzvan Alexandru , Costalat, Vincent , Fahed, Robert , Ghozy, Sherief , Shaikh, Hamza , Khalife, Jane , Abdalkader, Mohamad , Klein, Piers , Nguyen, Thanh N. , Heit, Jeremy J. , Regenhardt, Robert W. , Diestro, Jose Danilo Bengzon , Cancelliere, Nicole M , Amllay, Abdelaziz , Dusart, Anne , Bellante, Flavio, Rouchaud, Aymeric , Puri, Ajit S., Dyzmann, Christian , Kan, Peter , Colasurdo, Marco , Berge, Jérôme , Barreau, Xavier , Nedelcu, Simona , Henninger, Nils , Kyheng, Maéva , Marotta, Thomas R. , Stapleton, Christopher J. , Rabinov, James D. , Dofuku, Shogo , Tan, Benjamin Yong‐Qiang , Salazar‐Marioni, Sergio , Capirossi, Carolina , Mowla, Ashkan , Tjoumakaris, Stavropoula I, Khandelwal, Priyank , Biswas, Arundhati , Clarençon, Frédéric , Elhorany, Mahmoud , Premat, Kévin , Valente, Iacopo , Filipe, João Pedro , Varela, Ricardo , Quintero‐Consuegra, Miguel , Gonzalez, Nestor R. , Möhlenbruch, Markus , Tancredi, Illario , Yedavalli, Vivek , Chervak, Lina , Aziz, Yasmin , Stracke, Christian Paul , Hecker, Constantin , Hsieh, Cheng‐Yang , Liebeskind, David S. , Alexandre, Andrea , Faizy, Tobias D. , Patel, Aman B. , Lubicz, Boris , Guenego, Adrien , Klein, Piers , Nguyen, Thanh N , Heit, Jeremy J , Sweid, Ahmad , Bellante, Flavio , Forestier, Géraud , Kühn, Anna Luisa , Marnat, Gaultier , Ota, Takahiro , Dofuku, Shogo , Yeo, Leonard Ll , Salazar-Marioni, Sergio , Jabbour, Pascal , Gonzalez, Nestor R , Möhlenbruch, Markus A , Jesser, Jessica , Aziz, Yasmin , Faizy, Tobias D , Liebeskind, David S. , Ghozy, Sherief , Diestro, Jose Danilo B , Regenhardt, Robert W , Alexandru Radu, Răzvan , Fahed, Robert , Yedavalli, Vivek S , Cancelliere, Nicole M , Rouchaud, Aymeric , Colasurdo, Marco , Hecker, Constantin , Henninger, Nils , Tan, Benjamin Yq , Alexandre, Andrea M , Mowla, Ashkan , Varela, Ricardo , Siegler, James E. , Naamani, Kareem El , Meyer, Lukas , Forestier, Géraud , Saleme, Suzana , Mounayer, Charbel , Fiehler, Jens , Kühn, Anna Luisa , Puri, Ajit S , Sibon, Igor , Martinez-Gutierrez, Juan Carlos , Sheth, Sunil A , Renieri, Leonardo , Tjoumakaris, Stavropoula , Jabbour, Pascal , Khandelwal, Priyank , Pedicelli, Alessandro , Schiphorst, Adrien ter , Harker, Pablo , Gory, Benjamin , Killer-Oberpfalzer, Monika , Griessenauer, Christoph J. , Thomas, Ajith J , Weyland, Charlotte S. , Mendes Pereira, Vitor , Dmytriw, Adam A.
European Stroke Journal | October 27, 2023 | Volume: 9 | Issue: 1 | Pages: 114-123
Abstract Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.