Intra-Arterial Thrombolytic vs. Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Acute Ischemic Stroke: A Preliminary Multinational Multicenter Propensity Score-Matched Study.
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Salim Hamza Adel, Pulli Benjamin, Yedavalli Vivek, Ota Takahiro, Lakhani Dhairya, Hajjeh Orabi, Musmar Basel, Adeeb Nimer, Milhem Fathi, Faizy Tobias D, Naamani Kareem El, Henninger Nils, Sundararajan Sri Hari, Kühn Anna Luisa, Khalife Jane, Ghozy Sherief, Scarcia Luca, Yeo Leonard L L, Tan Benjamin Y Q, Regenhardt Robert W, Heit Jeremy J, Cancelliere Nicole M, Rouchaud Aymeric, Fiehler Jens, Sheth Sunil, Puri Ajit S, Dyzmann Christian, Colasurdo Marco, Renieri Leonardo, Filipe João Pedro, Harker Pablo, Radu Răzvan Alexandru, Abdalkader Mohamad, Klein Piers, Marotta Thomas R, Spears Julian, Mowla Ashkan, Jabbour Pascal, Biswas Arundhati, Clarençon Frédéric, Siegler James E, Nguyen Thanh N, Varela Ricardo, Baker Amanda, Essibayi Muhammed Amir, Altschul David, Gonzalez Nestor R, Möhlenbruch Markus A, Costalat Vincent, Gory Benjamin, Stracke Christian Paul, Hecker Constantin, Marnat Gaultier, Shaikh Hamza, Griessenauer Christoph J, Liebeskind David S, Pedicelli Alessandro, Alexandre Andrea M, Tancredi Illario, Kalsoum Erwah, Lubicz Boris, Patel Aman B, Pereira Vitor Mendes, Wintermark Max, Guenego Adrien, Dmytriw Adam A
Аннотация
PURPOSE: To compare functional outcomes and safety profiles of IAT versus MT in acute ischemic stroke caused by MCA DMVO (M2-M4 segments).
METHODS: We performed a retrospective, propensity score-matched study across 37 centers (Asia, Europe, North America) using the MAD-MT registry. Patients with MCA DMVO (M2-M4) treated with IAT or MT (with/without IVT) were included. Propensity score matching adjusted for confounders. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0-1 at 90 days).
RESULTS: After matching, 184 patients were analyzed (19 IAT, 165 MT). Baseline characteristics were balanced. At 90 days, excellent functional outcomes occurred in 38% (IAT) versus 21% (MT) (P = 0.20). Functional independence (mRS 0-2) rates were 50% (IAT) versus 40% (MT) (P = 0.42). Mortality was comparable (13% vs. 17%). Successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] 2b-3) was higher with MT (90% vs. 68%; P = 0.02), but symptomatic intracranial hemorrhage occurred only with MT (6.7% vs. 0%; P = 0.60).
CONCLUSION: For MCA DMVO, IAT showed similar functional outcomes and numerically fewer safety events than MT despite lower recanalization rates. These findings should be interpreted cautiously, given the small IAT sample size and require validation in larger prospective studies.