Multicenter evaluation of mechanical thrombectomy for distal medium vessel occlusions with National Institute of Health Stroke Scale Scores ≥ 6 and ≤ 6

被引：15

作者：

Kuehn, Anna Luisa ^{[1
]}

Puri, Ajit S. ^{[1
]}

Salim, Hamza Adel ^{[2
,9
,35
]}

Musmar, Basel ^{[2
]}

Ghozy, Sherief ^{[3
,4
]}

Siegler, James ^{[5
]}

Shaikh, Hamza ^{[5
]}

Khalife, Jane ^{[5
]}

Abdalkader, Mohamad ^{[6
,7
]}

Klein, Piers ^{[6
,7
]}

Nguyen, Thanh N. ^{[6
,7
]}

Heit, Jeremy J. ^{[8
]}

Regenhardt, Robert W. ^{[9
]}

Diestro, Jose Danilo Bengzon ^{[10
]}

Cancelliere, Nicole M. ^{[10
]}

Sweid, Ahmad ^{[11
]}

Naamani, Kareem El ^{[11
]}

Hasan, Zuha ^{[10
]}

Gopinathan, Anil ^{[12
]}

Amllay, Abdelaziz ^{[11
]}

Meyer, Lukas ^{[13
]}

Dusart, Anne ^{[14
]}

Bellante, Flavio ^{[14
]}

Forestier, Geraud ^{[15
]}

Rouchaud, Aymeric ^{[15
]}

Saleme, Suzana ^{[15
]}

Mounayer, Charbel ^{[15
]}

Fiehler, Jens ^{[13
]}

Dyzmann, Christian ^{[16
]}

Kan, Peter T. ^{[17
]}

Singh, Jasmeet ^{[9
]}

Colasurdo, Marco ^{[17
]}

Marnat, Gaultier ^{[18
]}

Berge, Jerome ^{[18
]}

Barreau, Xavier ^{[18
]}

Sibon, Igor ^{[19
]}

Nedelcu, Simona ^{[20
]}

Henninger, Nils ^{[20
]}

Marotta, Thomas R. ^{[11
]}

Stapleton, Christopher J. ^{[2
]}

Rabinov, James D. ^{[2
]}

Ota, Takahiro ^{[21
]}

Dofuku, Shogo ^{[21
]}

Yeo, Leonard LL. ^{[12
]}

Tan, Benjamin Y. Q. ^{[12
]}

Martinez-Gutierrez, Juan Carlos ^{[22
]}

Salazar-Marioni, Sergio ^{[22
]}

Sheth, Sunil ^{[23
]}

Renieri, Leonardo ^{[23
]}

Capirossi, Carolina ^{[23
]}

机构：

[1] Univ Massachusetts, Med Ctr, Dept Radiol, Div Neurointervent Radiol, Worcester, MA USA

[2] Louisiana State Univ, Dept Neurosurg & Intervent Neuroradiol, Los Angeles, CA 70803 USA

[3] Mayo Clin, Dept Neurol Surg, Rochester, MN USA

[4] Mayo Clin, Dept Radiol, Rochester, MN USA

[5] Rowen Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA

[6] Boston Med Ctr, Dept Radiol, Boston, MA USA

[7] Boston Med Ctr, Dept Neurol, Boston, MA USA

[8] Stanford Med Ctr, Dept Intervent Neuroradiol, Palo Alto, CA USA

[9] Harvard Univ, Brigham & Womens Hosp, Massachusetts Gen Hosp, Neuroendovascular Program, Boston, MA 02138 USA

[10] St Michaels Hosp, Neurovasc Ctr, Dept Med Imaging & Neurosurg, Toronto, ON, Canada

[11] Thomas Jefferson Univ, Dept Neurosurg, Philadelphia, PA USA

[12] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore

[13] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany

[14] Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium

[15] Univ Limoges, Univ Hosp Limoges, Neuroradiol Dept, Dupuytren,XLIM CNRS,UMR, Limoges, France

[16] Lubeck GmbH, Neuroradiol Dept, Sana Klin, Lubeck, Germany

[17] Univ Texas Med Branch, Dept Neurosurg, Galveston, TX USA

[18] Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France

[19] Bordeaux Univ Hosp, Neurol Dept, Bordeaux, France

[20] Univ Massachusetts, Chan Med Sch, Dept Neurol, Worcester, MA USA

[21] Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Tokyo, Japan

[22] UTHealth McGovern Med Sch, Dept Neurol, Houston, TX USA

[23] Osped Careggi Firenze, Interventist Neurovascolare, Florence, Italy

[24] Univ Southern Calif USC, Keck Sch Med, Dept Neurol Surg, Div Stroke & Endovascular Neurosurg, 1200 North State St,Suite 3300, Los Angeles, CA USA

[25] Dept Endovascular Neurosurg & Neuroradiol NJMS, Newark, NJ USA

[26] New York Med Coll, Westchester Med Ctr, Dept Neurosurg, Valhalla, NY USA

[27] Sorbonne Univ Paris VI, Pitie Salpetriere Hosp, Dept Neuroradiol, GRC BioFast, Paris, France

[28] Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Rome, Italy

[29] Ctr Hosp Univ Porto, Dept Diagnost & Intervent Neuroradiol, Porto, Portugal

[30] Ctr Hosp Univ Porto, Dept Neurol, Porto, Portugal

[31] Cedars Sinai Med Ctr, Dept Neurosurg, Los Angeles, CA USA

[32] Univ klin Heidelberg, Sekt Vaskulare & Interventionelle Neuroradiol, Heidelberg, Germany

[33] Montpellier Univ, Gui Chauliac Hosp, Med Ctr, Dept Neuroradiol, Montpellier, France

[34] Montpellier Univ, Gui Chauliac Hosp, Dept Neurol, Med Ctr, Montpellier, France

[35] Johns Hopkins Med Ctr, Dept Radiol, Div Neuroradiol, Baltimore, MD 21287 USA

[36] Univ Cincinnati, Med Ctr, Dept Neurol, Cincinnati, OH USA

[37] Univ Cincinnati, Dept Neurol & Radiol, Cincinnati, OH USA

[38] Nancy Univ Hosp, Dept Intervent Neuroradiol, Nancy, France

[39] Univ Med Ctr, Dept Radiol, Intervent Neuroradiol Sect, Munster, Germany

[40] Paracelsus Med Univ Salzburg, Dept Neurol, Christian Doppler Clin, Salzburg, Austria

[41] Paracelsus Med Univ Salzburg, Dept Neurosurg, Christian Doppler Clin, Salzburg, Austria

[42] Sin Lau Hosp, Neurol Dept, Tainan, Taiwan

[43] UCLA, UCLA Stroke Ctr, Los Angeles, CA USA

[44] UCLA, Dept Neurol Dept, Los Angeles, CA USA

[45] Ottawa Hosp, Ottawa Hosp Res Inst, Dept Med, Div Neurol, Ottawa, ON, Canada

[46] Univ Ottawa, Ottawa, ON, Canada

[47] Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium

[48] Univ Toronto, St Michaels Hosp, Dept Radiol, Div Diagnost & Therapeut Neuroradiol, Toronto, ON, Canada

来源：

JOURNAL OF NEUROLOGY | 2024年

基金：

美国国家卫生研究院;

关键词：

Endovascular technique; Stroke; Thrombectomy; Thrombolysis; Patient outcome; STENT-RETRIEVER THROMBECTOMY; ENDOVASCULAR TREATMENT; ISCHEMIC-STROKE; CIRCULATION; GUIDELINES;

D O I：

10.1007/s00415-024-12537-4

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background While mechanical thrombectomy is considered standard of care for large vessel occlusions, scientific evidence to support treatment for distal and medium vessel occlusions remains scarce. Purpose To evaluate feasibility, safety, and outcomes in patients with low National Institute of Health Stroke Scale scores undergoing mechanical thrombectomy for treatment of distal medium vessel occlusions. Materials and methods Retrospective data review and analysis of prospectively maintained databases at 41 academic centers in North America, Asia, and Europe between January 2017 and January 2022. Characteristics and outcomes were compared between groups with low stroke scale score (<= 6) versus and higher stroke scale scores (> 6). Propensity score matching using the optimal pair matching method and 1:1 ratio was performed. Results Data were collected on a total of 1068 patients. After propensity score matching, there were a total of 676 patients included in the final analysis, with 338 patients in each group. High successful reperfusion rates were seen in both groups, 90.2% in <= 6 and 88.7% in the > 6 stroke scale groups. The frequency of excellent and good functional outcome was seen more common in low versus higher stroke scale score patients (64.5% and 81.1% versus 39.3% and 58.6%, respectively). The 90-day mortality rate observed in the <= 6 stroke scale group was 5.3% versus 13.3% in the > 6 stroke scale group. Conclusion Mechanical thrombectomy in distal and medium vessel occlusions, specifically in patients with low stroke scale scores is feasible, though it may not necessarily improve outcomes over IVT.

引用

页码：5853 / 5863

页数：11

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