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Symptomatic intracerebral hemorrhage in proximal and distal medium middle cerebral artery occlusion patients treated with mechanical thrombectomy

Background - Acute ischemic stroke (AIS) caused by distal medium vessel occlusions (DMVOs) represents a significant proportion of overall stroke cases. While intravenous thrombolysis (IVT) has been a primary treatment, advancements in endovascular procedures have led to increased use o...

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Main Authors: Yedavalli, Vivek S. (Author) , Salim, Hamza Adel (Author) , Musmar, Basel (Author) , Adeeb, Nimer (Author) , Essibayi, Muhammed Amir (Author) , ElNaamani, Kareem (Author) , Henninger, Nils (Author) , Sundararajan, Sri Hari (Author) , Kuhn, Anna Luisa (Author) , Khalife, Jane (Author) , Ghozy, Sherief (Author) , Scarcia, Luca (Author) , Tan, Benjamin YQ (Author) , Heit, Jeremy Josef (Author) , Regenhardt, Robert W. (Author) , Cancelliere, Nicole M. (Author) , Bernstock, Joshua D. (Author) , Rouchaud, Aymeric (Author) , Fiehler, Jens (Author) , Sheth, Sunil A. (Author) , Puri, Ajit S. (Author) , Dyzmann, Christian (Author) , Colasurdo, Marco (Author) , Barreau, Xavier (Author) , Renieri, Leonardo (Author) , Filipe, João Pedro (Author) , Harker, Pablo (Author) , Radu, Răzvan Alexandru (Author) , Marotta, Thomas R. (Author) , Spears, Julian (Author) , Ota, Takahiro (Author) , Mowla, Ashkan (Author) , Jabbour, Pascal (Author) , Biswas, Arundhati (Author) , Clarençon, Frédéric (Author) , Siegler, James E. (Author) , Nguyen, Thanh N. (Author) , Varela, Ricardo (Author) , Baker, Amanda (Author) , Altschul, David (Author) , Gonzalez, Nestor (Author) , Möhlenbruch, Markus Alfred (Author) , Costalat, Vincent (Author) , Gory, Benjamin (Author) , Stracke, Paul (Author) , Aziz-Sultan, Mohammad Ali (Author) , Hecker, Constantin (Author) , Shaikh, Hamza (Author) , Liebeskind, David S. (Author) , Pedicelli, Alessandro (Author) , Alexandre, Andrea M. (Author) , Tancredi, Illario (Author) , Faizy, Tobias D. (Author) , Kalsoum, Erwah (Author) , Lubicz, Boris (Author) , Patel, Aman B. (Author) , Mendes Pereira, Vitor (Author) , Guenego, Adrien (Author) , Dmytriw, Adam A. (Author)
Format: Article (Journal)
Language:English
Published: July 24
In: Journal of neuroInterventional surgery
Year: 2025, Volume: 17, Issue: 8, Pages: 803-810
ISSN:1759-8486
DOI:10.1136/jnis-2024-021879
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/jnis-2024-021879
Verlag, lizenzpflichtig, Volltext: https://jnis.bmj.com/lookup/doi/10.1136/jnis-2024-021879
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Author Notes:Vivek S Yedavalli, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Muhammed Amir Essibayi, Kareem ElNaamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kuhn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Benjamin YQ Tan, Jeremy Josef Heit, Robert W Regenhardt, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil A Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Adrien Guenego, Adam A Dmytriw, the MAD MT Investigators
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Summary:Background - Acute ischemic stroke (AIS) caused by distal medium vessel occlusions (DMVOs) represents a significant proportion of overall stroke cases. While intravenous thrombolysis (IVT) has been a primary treatment, advancements in endovascular procedures have led to increased use of mechanical thrombectomy (MT) in DMVO stroke patients. However, symptomatic intracerebral hemorrhage (sICH) remains a critical complication of AIS, particularly after undergoing intervention. This study aims to identify factors associated with sICH in DMVO stroke patients undergoing MT. - - - Methods - This retrospective analysis utilized data from the Multicenter Analysis of Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. Middle cerebral artery (MCA) DMVO stroke patients were included. The primary outcome measured was sICH, as defined per the Heidelberg Bleeding Classification. Univariable and multivariable logistic regression were used to identify factors independently associated with sICH. - - - Results - Among 1708 DMVO stroke patients, 148 (8.7%) developed sICH. Factors associated with sICH in DMVO patients treated with MT included older age (adjusted odds ratio (aOR) 1.01, 95% confidence interval (95% CI) 1.00 to 1.03, P=0.048), distal occlusion site (M3, M4) compared with medium occlusions (M2) (aOR 1.71, 95% CI 1.07 to 2.74, P=0.026), prior use of antiplatelet drugs (aOR 2.06, 95% CI 1.41 to 2.99, P<0.001), lower Alberta Stroke Program Early CT Scores (ASPECTS) (aOR 0.75, 95% CI 0.66 to 0.84, P<0.001), higher preoperative blood glucose level (aOR 1.00, 95% CI 1.00 to 1.01, P=0.012), number of passes (aOR 1.27, 95% CI 1.15 to 1.39, P<0.001), and successful recanalization (Thrombolysis In Cerebral Infarction (TICI) 2b-3) (aOR 0.43, 95% CI 0.28 to 0.66, P<0.001). - - - Conclusion - This study provides novel insight into factors associated with sICH in patients undergoing MT for DMVO, emphasizing the importance of age, distal occlusion site, prior use of antiplatelet drugs, lower ASPECTS, higher preoperative blood glucose level, and procedural factors such as the number of passes and successful recanalization. Pending confirmation, consideration of these factors may improve personalized treatment strategies.
Item Description:Gesehen am 14.04.2025
Physical Description:Online Resource
ISSN:1759-8486
DOI:10.1136/jnis-2024-021879

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