Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study

被引：27

作者：

Meyer, Lukas ^{[1
]}

Stracke, Paul ^{[1
,2
,4
]}

Broocks, Gabriel ^{[1
]}

Elsharkawy, Mohamed ^{[2
,12
]}

Sporns, Peter ^{[1
]}

Piechowiak, Eike, I ^{[5
]}

Kaesmacher, Johannes ^{[5
]}

Maegerlein, Christian ^{[6
]}

Petzsche, Moritz Roman Hernandez ^{[6
]}

Zimmermann, Hanna ^{[7
]}

Naziri, Weis ^{[29
,30
]}

Abdullayev, Nuran ^{[8
]}

Kabbasch, Christoph ^{[8
]}

Diamandis, Elie ^{[9
]}

Thormann, Maximilian ^{[9
]}

Maus, Volker ^{[10
]}

Fischer, Sebastian ^{[10
]}

Moehlenbruch, Markus ^{[11
]}

Weyland, Charlotte S. ^{[11
]}

Ernst, Marielle

Jamous, Ala ^{[12
]}

Meila, Dan ^{[13
]}

Miszczuk, Milena ^{[14
]}

Siebert, Eberhard ^{[14
]}

Lowens, Stephan ^{[15
]}

Krause, Lars Udo ^{[16
]}

Yeo, Leonard ^{[17
,18
]}

Tan, Benjamin ^{[17
,18
]}

Gopinathan, Anil ^{[18
,19
]}

Arenillas-Lara, Juan F. ^{[35
]}

Navia, Pedro ^{[33
]}

Raz, Eytan ^{[22
]}

Shapiro, Maksim ^{[22
]}

Arnberg, Fabian ^{[23
,24
]}

Zelenak, Kamil ^{[31
,32
]}

Martinez-Galdamez, Mario ^{[21
]}

Alexandrou, Maria ^{[27
]}

Kastrup, Andreas ^{[26
]}

Papanagiotou, Panagiotis ^{[27
,28
]}

Kemmling, Andre ^{[34
]}

Dorn, Franziska ^{[7
,20
]}

Psychogios, Marios ^{[4
]}

Andersson, Tommy ^{[23
,24
,25
]}

Chapot, Rene ^{[3
]}

Fiehler, Jens ^{[1
]}

Hanning, Uta ^{[1
]}

机构：

[1] Univ Med Ctr Hamburg Eppendorf, Dept Diag & Intervent Neuroradiol, Martinistr 52, D-20246 Hamburg, Germany

[2] Univ Hosp Muenster, Dept Intervent Neuroradiol, Munster, Germany

[3] Alfried Krupp Hosp Essen, Dept Endovasc Therapy, Essen, Germany

[4] Univ Basel Hosp, Dept Diag & Intervent Neuroradiol, Basel, Switzerland

[5] Univ Bern, Univ Hosp Bern, Inselspital, Inst Diag & Intervent Neuroradiol, Bern, Switzerland

[6] Tech Univ Munich, Klinikum Rechts Isar, Sch Med, Dept Diag & Intervent Neuroradiol, Munich, Germany

[7] Ludwig Maximilians Univ Munchen, Inst Neuroradiol, Univ Hosp, Munich, Germany

[8] Univ Cologne, Dept Neuroradiol, Cologne, Germany

[9] Univ Hosp Magdeburg, Dept Neuroradiol, Magdeburg, Germany

[10] Univ Bochum, Univ Klin Ruhr, Univ Knappschafts krankenhaus Bochum, Dept Diag Radiol & Intervent Neuroradiol & Nucl, Bochum, Germany

[11] Univ Heidelberg Hosp, Dept Neuroradiol Heidelberg, Heidelberg, Germany

[12] Univ Med Ctr Goettingen, Dept Diag & Intervent Neuroradiol, Gottingen, Germany

[13] Johanna Etienne Hosp, Dept Intervent Neuroradiol, Neuss, Germany

[14] Charite Med Univ Berlin, Inst Neuroradiol, Berlin, Germany

[15] Klinikum Osnabruck, Dept Radiol, Osnabruck, Germany

[16] Klinikum Osnabruck, Dept Neurol, Osnabruck, Germany

[17] Natl Univ Hlth Syst, Dept Med, Div Neurol, Singapore, Singapore

[18] Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore

[19] Natl Univ Hlth Syst, Dept Diag Imaging, Div Intervent Radiol, Singapore, Singapore

[20] Univ Hosp Bonn, Dept Neuroradiol, Bonn, Germany

[21] Univ Valladolid, Dept Intervent Neuroradiol, Hosp Clin, Valladolid, Spain

[22] New York Langone Med Ctr, Dept Radiol, New York, NY USA

[23] Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden

[24] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden

[25] AZ Groeninge, Dept Med Imaging, Kortrijk, Belgium

[26] Hosp Bremen Mitte, Dept Neurol, Bremen, Germany

[27] Hosp Bremen Mitte, Dept Diag & Intervent Neuroradiol, Bremen, Germany

[28] Natl & Kapodistrian Univ Athens, Areteion Univ Hosp, Dept Radiol, Athens, Greece

[29] Westpfalz Klinikum, Dept Neuroradiol, Kaiserslautern, Germany

[30] Univ Hosp Luebeck, Dept Neuroradiol, Lubeck, Germany

[31] Comenius Univ, Jessenius Fac Med, Martin, TN, Slovakia

[32] Comenius Univ, Univ Hosp, Martin, TN, Slovakia

[33] Hosp Univ La Paz, Dept Neuroradiol, Madrid, Spain

[34] Univ Hosp Marburg, Dept Neuroradiol, Marburg, Germany

[35] Univ Valladolid, Hosp Clin, Stroke Unit, Valladolid, Spain

来源：

RADIOLOGY | 2023年 / 307卷 / 02期

关键词：

ACUTE ISCHEMIC-STROKE; MECHANICAL THROMBECTOMY; INTRAVENOUS ALTEPLASE; TERRITORY INFARCTION; VESSEL OCCLUSION; TRIAL; COMPLICATIONS; METAANALYSIS; EFFICACY; THERAPY;

D O I：

10.1148/radiol.220229

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Background: Evidence supporting a potential benefit of thrombectomy for distal medium vessel occlusions (DMVOs) of the anterior cerebral artery (ACA) is, to the knowledge of the authors, unknown. Purpose: To compare the clinical and safety outcomes between mechanical thrombectomy (MT) and best medical treatment (BMT) with or without intravenous thrombolysis for primary isolated ACA DMVOs. Materials and Methods: Treatment for Primary Medium Vessel Occlusion Stroke, or TOPMOST, is an international, retrospective, multicenter, observational registry of patients treated for DMVO in daily practice. Patients treated with thrombectomy or BMT alone for primary ACA DMVO distal to the A1 segment between January 2013 and October 2021 were analyzed and compared by one-to-one propensity score matching (PSM). Early outcome was measured by the median improvement of National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours. Favorable functional outcome was defined as modified Rankin scale scores of 0-2 at 90 days. Safety was assessed by the occurrence of symptomatic intracerebral hemorrhage and mortality. Results: Of 154 patients (median age, 77 years; quartile 1 [Q1] to quartile 3 [Q3], 66-84 years; 80 men; 94 patients with MT; 60 patients with BMT) who met the inclusion criteria, 110 patients (median age, 76 years; Q1-Q3, 67-83 years; 50 men; 55 patients with MT; 55 patients with BMT) were matched. DMVOs were in A2 (82 patients; 53%), A3 (69 patients; 45%), and A3 (three patients; 2%). After PSM, the median 24-hour NIHSS point decrease was -2 (Q1-Q3, -4 to 0) in the thrombectomy and -1 (Q1-Q3, -4 to 1.25) in the BMT cohort (P = .52). Favorable functional outcome (MT vs BMT, 18 of 37 [49%] vs 19 of 39 [49%], respectively; P = .99) and mortality (MT vs BMT, eight of 37 [22%] vs 12 of 39 [31%], respectively; P = .36) were similar in both groups. Symptomatic intracranial hemorrhage occurred in three (2%) of 154 patients. Conclusion: Thrombectomy appears to be a safe and technically feasible treatment option for primary isolated anterior cerebral artery occlusions in the A2 and A3 segment with clinical outcomes similar to best medical treatment with and without intravenous thrombolysis. (c) RSNA, 2023

引用

页数：11

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