Médecine

Paramédical

Autres domaines


Suscribirse

Safety and effectiveness of mechanical thrombectomy for primary isolated distal vessel occlusions: A monocentric retrospective comparative study - 18/06/22

Doi : 10.1016/j.neurad.2022.03.008 
Mahmoud Elhorany a, b, c, , Charlotte Rosso d, e, Eimad Shotar b, Flore Baronnet-Chauvet e, Kévin Premat b, Stéphanie Lenck b, Sophie Crozier e, Céline Corcy b, Laure Bottin e, Ossama Yassin Mansour f, Atika Talbi b, El-Sayed Ali Tag El-din c, Wael Ahmed Fadel c, Nader-Antoine Sourour b, Sonia Alamowitch e, Yves Samson d, e, Frédéric Clarençon a, b
a GRC-14 BiosFast, Sorbonne University, Paris, France 
b Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France 
c Department of Neurology, Faculty of Medicine, Tanta University, Egypt 
d Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS Hôpital Pitié-Salpêtrière, Paris, France 
e AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, DMU Neuroscience, 75013, Paris, France 
f Department of Neurology, Faculty of Medicine, Alexandria University, Egypt 

Corresponding author at: Neuroradiology Department, Pitie-Salpetriere Hospital, 47-83-Boulevard de l'Hôpital, 75013, Paris, France.Neuroradiology DepartmentPitie-Salpetriere Hospital47-83-Boulevard de l'Hôpital75013ParisFrance

Abstract

Background

Distal vessel occlusions represent about 25-40% of acute ischemic stroke (AIS), either as primary occlusion or secondary occlusion complicating mechanical thrombectomy (MT) for large vessel occlusion.

Objective

Our aim was to evaluate safety and effectiveness of MT associated with the best medical treatment (BMT) in the management of AIS patients with distal vessel occlusion in comparison with the BMT alone.

Methods

Retrospective analysis was conducted on AIS patients treated by MT+BMT for primary distal vessel occlusion between 2015 and 2020, and were compared with a historic cohort managed by BMT alone between 2006 and 2015 selected based on the same inclusion criteria. A secondary analysis was conducted using propensity score matching (PSM) including the following: NIHSS, age and treatment with intravenous thrombolysis (IVT) as covariates.

Results

Of 650 patients screened, 44 patients with distal vessel occlusions treated by MT+BMT were selected and compared with 36 patients who received BMT alone. After PSM, 28 patients in each group were matched without significant difference. Good clinical outcome defined as mRS≤2 was achieved by 53.6% of the MT+BMT group and 57% of the BMT group (OR, 0.87; 95%CI, 0.3–2.4; p = 1.00). The mortality rate was comparable in both groups (7% vs. 10.7% in MT+BMT and BMT patients, respectively; OR=0.64; 95%CI, 0.1-4; p = 1.00). Symptomatic intracranial hemorrhage (ICH) was seen in only one patient treated by MT+BMT (3.6%).

Conclusion

Mechanical thrombectomy seems to be comparable with the best medical treatment regarding the effectiveness and safety in the management of patients with distal vessel occlusions.

El texto completo de este artículo está disponible en PDF.

Graphical abstract




Image, graphical abstract

El texto completo de este artículo está disponible en PDF.

Highlights

Distal vessel occlusions (DVOs) represent about 25 - 40% of acute ischemic stroke.
There are insufficient data to ascertain whether mechanical thrombectomy (MT) plus best medical treatment (BMT) is superior to BMT alone in DVOs.
In our study, MT+BMT and BMT alone were found to achieve similar rates of good clinical outcome despite higher final successful recanalisation rate in MT+BMT group.
The 3-months mortality rate was comparable between both groups.
Despite that MT and BMT seem to be comparable in the management of DVOs, larger-sample randomised studies are warranted.

El texto completo de este artículo está disponible en PDF.

Keywords : Distal occlusion, Middle cerebral artery, M2, M3, Anterior cerebral artery occlusion, Posterior cerebral artery occlusion, Acute ischemic stroke, Mechanical thrombectomy, Reperfusion, Outcome

Abbreviations : DVOs, AIS, MT, LVO, BMT, IVT, mTICI, AOL, mRS, ICH, NIHSS, GA, MCA


Esquema


© 2022  Elsevier Masson SAS. Reservados todos los derechos.
Añadir a mi biblioteca Eliminar de mi biblioteca Imprimir
Exportación

    Exportación citas

  • Fichero

  • Contenido

Vol 49 - N° 4

P. 311-316 - juin 2022 Regresar al número
Artículo precedente Artículo precedente
  • The evolution of distal thrombectomy warrants targeted RCTs
  • Mohamed Abdelrady, Julien Ognard
| Artículo siguiente Artículo siguiente
  • Benefit of mechanical thrombectomy in acute ischemic stroke related to calcified cerebral embolus
  • Téodor Grand, Cyril Dargazanli, Chrysanthi Papagiannaki, Agnetha Bruggeman, Christoph Maurer, Gregory Gascou, Cédric Fauche, Romain Bourcier, Guillaume Tessier, Raphaël Blanc, Malek Ben Machaa, Gaultier Marnat, Xavier Barreau, Julien Ognard, Jean-Christophe Gentric, Charlotte Barbier, Benjamin Gory, Christine Rodriguez, Grégoire Boulouis, François Eugène, Pierre Thouant, Frederic Ricolfi, Kevin Janot, Denis Herbreteau, Omer Faruk Eker, Matteo Cappucci, Tomas Dobrocky, Markus Möhlenbruch, Theo Demerath, Marios Psychogios, Sebastian Fischer, Alessandro Cianfoni, Charles Majoie, Bart Emmer, Henk Marquering, Rémi Valter, Stéphanie Lenck, Kévin Premat, Jonathan Cortese, Didier Dormont, Nader-Antoine Sourour, Eimad Shotar, Yves Samson, Frédéric Clarençon

Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
El acceso al texto completo de este artículo requiere una suscripción.

¿Ya suscrito a @@106933@@ revista ?

Mi cuenta


Declaración CNIL

EM-CONSULTE.COM se declara a la CNIL, la declaración N º 1286925.

En virtud de la Ley N º 78-17 del 6 de enero de 1978, relativa a las computadoras, archivos y libertades, usted tiene el derecho de oposición (art.26 de la ley), el acceso (art.34 a 38 Ley), y correcta (artículo 36 de la ley) los datos que le conciernen. Por lo tanto, usted puede pedir que se corrija, complementado, clarificado, actualizado o suprimido información sobre usted que son inexactos, incompletos, engañosos, obsoletos o cuya recogida o de conservación o uso está prohibido.
La información personal sobre los visitantes de nuestro sitio, incluyendo su identidad, son confidenciales.
El jefe del sitio en el honor se compromete a respetar la confidencialidad de los requisitos legales aplicables en Francia y no de revelar dicha información a terceros.