Salim Hamza Adel, Yedavalli Vivek, Musmar Basel, Adeeb Nimer, Essibayi Muhammed Amir, Naamani Kareem El, Henninger Nils, Sundararajan Sri Hari, Kühn Anna Luisa, Khalife Jane, Ghozy Sherief, Scarcia Luca, Tan Benjamin Y Q, Pulli Benjamin, Heit Jeremy J, Regenhardt Robert W, Cancelliere Nicole M, Bernstock Joshua D, Rouchaud Aymeric, Fiehler Jens, Sheth Sunil, Puri Ajit S, Dyzmann Christian, Colasurdo Marco, Barreau Xavier, Renieri Leonardo, Filipe João Pedro, Harker Pablo, Radu Razvan Alexandru, Marotta Thomas R, Spears Julian, Ota Takahiro, Mowla Ashkan, Jabbour Pascal, Biswas Arundhati, Clarençon Frédéric, Siegler James E, Nguyen Thanh N, Varela Ricardo, Baker Amanda, Altschul David, Gonzalez Nestor R, Möhlenbruch Markus A, Costalat Vincent, Gory Benjamin, Stracke Christian Paul, Aziz-Sultan Mohammad Ali, Hecker Constantin, Shaikh Hamza, Liebeskind David S, Pedicelli Alessandro, Alexandre Andrea M, Tancredi Illario, Faizy Tobias D, Kalsoum Erwah, Lubicz Boris, Patel Aman B, Pereira Vitor Mendes, Guenego Adrien, Dmytriw Adam A
Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
J Stroke. 2024 Sep;26(3):434-445. doi: 10.5853/jos.2024.01389. Epub 2024 Sep 13.
The management of acute ischemic stroke (AIS) due to distal medium vessel occlusion (DMVO) remains uncertain, particularly in comparing the effectiveness of intravenous thrombolysis (IVT) plus mechanical thrombectomy (MT) versus IVT alone. This study aimed to evaluate the safety and efficacy in DMVO patients treated with either MT-IVT or IVT alone.
This multinational study analyzed data from 37 centers across North America, Asia, and Europe. Patients with AIS due to DMVO were included, with data collected from September 2017 to July 2023. The primary outcome was functional independence, with secondary outcomes including mortality and safety measures such as types of intracerebral hemorrhage.
The study involved 1,057 patients before matching, and 640 patients post-matching. Functional outcomes at 90 days showed no significant difference between groups in achieving good functional recovery (modified Rankin Scale 0-1 and 0-2), with adjusted odds ratios (OR) of 1.21 (95% confidence interval [CI] 0.81 to 1.79; P=0.35) and 1.00 (95% CI 0.66 to 1.51; P>0.99), respectively. Mortality rates at 90 days were similar between the two groups (OR 0.75, 95% CI 0.44 to 1.29; P=0.30). The incidence of symptomatic intracerebral hemorrhage was comparable, but any type of intracranial hemorrhage was significantly higher in the MT-IVT group (OR 0.43, 95% CI 0.29 to 0.63; P<0.001).
The results of this study indicate that while MT-IVT and IVT alone show similar functional and mortality outcomes in DMVO patients, MT-IVT presents a higher risk of hemorrhagic complications, thus MT-IVT may not routinely offer additional benefits over IVT alone for all DMVO stroke patients. Further prospective randomized trials are needed to identify patient subgroups most likely to benefit from MT-IVT treatment in DMVO.
远端中等血管闭塞（DMVO）所致急性缺血性卒中（AIS）的治疗仍不明确，尤其是在比较静脉溶栓（IVT）联合机械取栓（MT）与单纯IVT的疗效方面。本研究旨在评估接受MT-IVT或单纯IVT治疗的DMVO患者的安全性和疗效。
这项跨国研究分析了来自北美、亚洲和欧洲37个中心的数据。纳入因DMVO导致AIS的患者，数据收集时间为2017年9月至2023年7月。主要结局是功能独立性，次要结局包括死亡率和安全指标，如脑出血类型。
匹配前该研究纳入1057例患者，匹配后纳入640例患者。90天时的功能结局显示，两组在实现良好功能恢复（改良Rankin量表0-1和0-2）方面无显著差异，调整后的优势比（OR）分别为1.21（95%置信区间[CI]0.81至1.79；P=0.35）和1.00（95%CI0.66至1.51；P>0.99）。两组90天死亡率相似（OR0.75，95%CI0.44至1.29；P=0.30）。症状性脑出血的发生率相当，但MT-IVT组任何类型的颅内出血明显更高（OR0.43，95%CI0.29至0.63；P<0.001）。
本研究结果表明，虽然MT-IVT和单纯IVT在DMVO患者中显示出相似的功能和死亡率结局，但MT-IVT出血并发症风险更高，因此对于所有DMVO卒中患者，MT-IVT可能不会比单纯IVT常规提供更多益处。需要进一步的前瞻性随机试验来确定最有可能从DMVO的MT-IVT治疗中获益的患者亚组。
