Journal article
Endovascular Therapy vs Medical Management for Patients With Acute Stroke With Medium Vessel Occlusion in the Anterior Circulation
JAMA network open, Vol.5(10), pp.e2238154-e2238154
10/03/2022
DOI: 10.1001/jamanetworkopen.2022.38154
PMCID: PMC9593229
PMID: 36279137
Abstract
ImportanceRandomized clinical trials have shown the efficacy of endovascular therapy (EVT) for acute large vessel occlusion strokes. The benefit of EVT in acute stroke with distal, medium vessel occlusion (DMVO) remains unclear. ObjectiveTo examine the efficacy and safety outcomes associated with EVT in patients with primary DMVO stroke when compared with a control cohort treated with medical management (MM) alone. Design, Setting, and ParticipantsThis multicenter, retrospective cohort study pooled data from patients who had an acute stroke and a primary anterior circulation emergency DMVO, defined as any segment of the anterior cerebral artery (ACA) or distal middle cerebral artery, between January 1, 2015, and December 31, 2019. Those with a concomitant proximal occlusion were excluded. Outcomes were compared between the 2 treatment groups using propensity score methods. Data analysis was performed from March to June 2021. ExposuresPatients were divided into EVT and MM groups. Main Outcomes and MeasuresMain efficacy outcomes included 3-month functional independence (modified Rankin Scale [mRS] scores, 0-2) and 3-month excellent outcome (mRS scores, 0-1). Safety outcomes included 3-month mortality and symptomatic intracranial hemorrhage. ResultsA total of 286 patients with DMVO were evaluated, including 156 treated with EVT (mean [SD] age, 66.7 [13.7] years; 90 men [57.6%]; median National Institute of Health Stroke Scale [NIHSS] score, 13.5 [IQR, 8.5-18.5]; intravenous tissue plasminogen activator [IV tPA] use, 75 [49.7%]; ACA involvement, 49 [31.4%]) and 130 treated with medical management (mean [SD] age, 69.8 [14.9] years; 62 men [47.7%]; median NIHSS score, 7.0 [IQR, 4.0-14.0], IV tPA use, 58 [44.6%]; ACA involvement, 31 [24.0%]). There was no difference in the unadjusted rate of 3-month functional independence in the EVT vs MM groups (151 [51.7%] vs 124 [50.0%]; P = .78), excellent outcome (151 [38.4%] vs 123 [31.7%]; P = .25), or mortality (139 [18.7%] vs 106 [11.3%]; P = .15). The rate of symptomatic intracranial hemorrhage was similar in the EVT vs MM groups (weighted: 4.0% vs 3.1%; P = .90). In inverse probability of treatment weighting propensity analyses, there was no significant difference between groups for functional independence (adjusted odds ratio [aOR], 1.36; 95% CI, 0.84-2.19; P = .20) or mortality (aOR, 1.24; 95% CI, 0.63-2.43; P = .53), whereas the EVT group had higher odds of an excellent outcome (mRS scores, 0-1) at 3 months (aOR, 1.71; 95% CI, 1.02-2.87; P = .04). Conclusions and RelevanceThe findings of this multicenter cohort study suggest that EVT may be considered for selected patients with ACA or distal middle cerebral artery strokes. Further larger randomized investigation regarding the risk-benefit ratio for DMVO treatment is indicated.
Details
- Title: Subtitle
- Endovascular Therapy vs Medical Management for Patients With Acute Stroke With Medium Vessel Occlusion in the Anterior Circulation
- Creators
- Hamidreza Saber - University of California, Los AngelesShashvat M Desai - HonorHealthDiogo Haussen - Grady Memorial HospitalAlhamza Al-Bayati - University of PittsburghShahram Majidi - Icahn School of Medicine at Mount SinaiJ Mocco - Icahn School of Medicine at Mount SinaiAmeer E Hassan - The University of Texas Rio Grande ValleyGary Rajah - Munson Medical CenterMuhammad Waqas - University at Buffalo, State University of New YorkJason M Davies - University at Buffalo, State University of New YorkDavid Dornbos - University of Tennessee Health Science CenterChristopher Nickele - University of Tennessee Health Science CenterAdam S Arthur - University of Tennessee Health Science CenterAshkan Mowla - Department of Neurosurgery, University of South California, Los AngelesMatthew S Tenser - Department of Neurosurgery, University of South California, Los AngelesMaxim Mokin - University of South FloridaElliot Pressman - University of South FloridaAmin Aghaebrahim - Baptist Neurological Institute, Lyerly Neurosurgery, Baptist Health, Jacksonville, FloridaRicardo A Hanel - Baptist Neurological Institute, Lyerly Neurosurgery, Baptist Health, Jacksonville, FloridaSantiago Ortega-Gutierrez - University of IowaTudor Jovin - Cooper University Health CareGary R Duckwiler - University of California, Los AngelesDavid S Liebeskind - University of California, Los AngelesRaul G Nogueira - University of PittsburghJeffrey Gornbein - University of California, Los AngelesJeffrey L Saver - University of California, Los AngelesAshutosh P Jadhav - Barrow Neurological Institute
- Resource Type
- Journal article
- Publication Details
- JAMA network open, Vol.5(10), pp.e2238154-e2238154
- DOI
- 10.1001/jamanetworkopen.2022.38154
- PMID
- 36279137
- PMCID
- PMC9593229
- NLM abbreviation
- JAMA Netw Open
- eISSN
- 2574-3805
- Language
- English
- Date published
- 10/03/2022
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984307145602771
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