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Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions

Objective - Mechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still...

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Main Authors: Chafai, Imene (Author) , Salim, Hamza (Author) , Musmar, Basel (Author) , Adeeb, Nimer (Author) , Yedavalli, Vivek (Author) , ElNaamani, Kareem (Author) , Henninger, Nils (Author) , Nedelcu, Simona (Author) , Sundararajan, Sri Hari (Author) , Kühn, 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) , Essibayi, Muhammed Amir (Author) , Puri, Ajit S (Author) , Dyzmann, Christian (Author) , Colasurdo, Marco (Author) , Marnat, Gaultier (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) , Nguyen, Thanh N (Author) , Varela, Ricardo (Author) , Baker, Amanda (Author) , Altschul, David (Author) , Gonzalez, Nestor (Author) , Möhlenbruch, Markus Alfred (Author) , Costalat, V (Author) , Gory, Benjamin (Author) , Stracke, Paul (Author) , Aziz-Sultan, Mohammad A. (Author) , Hecker, Constantin (Author) , Shaikh, Hamza (Author) , Liebeskind, David S. (Author) , Pedicelli, Alessandro (Author) , Alexandre, Andrea Maria (Author) , Tancredi, Illario (Author) , Faizy, Tobias D (Author) , Kalsoum, Erwah (Author) , Patel, Aman B (Author) , Fahed, Robert (Author) , Wang, Maud (Author) , Pereira, Vitor Mendes (Author) , Lubicz, Boris (Author) , Dmytriw, Adam A (Author) , Guenego, Adrien (Author)
Format: Article (Journal)
Language:English
Published: July 16, 2025
In: Interventional neuroradiology
Year: 2025, Pages: 1-10
ISSN:2385-2011
DOI:10.1177/15910199251342841
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1177/15910199251342841
Verlag, lizenzpflichtig, Volltext: https://journals.sagepub.com/doi/10.1177/15910199251342841
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Author Notes:Imene Chafai, Hamza Salim, Basel Musmar, Nimer Adeeb, Vivek Yedavalli, Kareem ElNaamani, Nils Henninger, Simona Nedelcu, Sri Hari Sundararajan, Anna Luisa Kühn, 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, Muhammed Amir Essibayi, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Gaultier Marnat, 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, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor Gonzalez, Markus A Möhlenbruch, V Costalat, Benjamin Gory, Paul Stracke, Mohammad A. Aziz-Sultan, Constantin Hecker, Hamza Shaikh, David S. Liebeskind, Alessandro Pedicelli, Andrea Maria Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Aman B Patel, Robert Fahed, Maud Wang, Vitor Mendes Pereira, Boris Lubicz, Adam A Dmytriw, Adrien Guenego and On behalf of the MAD MT Investigators
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Summary:Objective - Mechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still experience poor long-term clinical outcomes, prompting our study to comprehensively explore pre-MT factors influencing outcome despite excellent recanalization (final modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2c). - Methods - We retrospectively examined data from patients who consecutively underwent MT for a primary middle cerebral artery (MCA) DMVO across 37 centers in North America, Asia, and Europe. We identified baseline clinical and imaging factors associated with poor clinical outcome (defined as a modified Rankin Scale [mRS] score of 3-6) at 3 months, despite excellent recanalization using a multivariable model. - Results - Between September 2017 and July 2021, 623 patients achieved mTICI > 2b and they were included in our study. Among them, 198 (32%) experienced a poor clinical outcome (mRS 3-6). Predictors of poor clinical outcome included higher age (OR 1.05 [1.03-1.07], p < 0.001), higher NIHSS at admission (OR 1.12 [1.08-1.15], p < 0.001), higher baseline mRS (OR 1.77 [0.96-3.26], p = 0.067), and diabetes (OR 1.59 [1.01-2.48], p = 0.044). Higher ASPECTS was associated with a decreased risk of poor clinical outcome (OR 0.82 [0.71-0.94], p = 0.006). - Conclusion - Older age, diabetes, higher baseline mRS, and NIHSS were associated with poor clinical outcome in MCA DMVO despite excellent recanalization. Conversely, a higher ASPECTS decreased the probability of such an outcome.
Item Description:Gesehen am 12.01.2026
Physical Description:Online Resource
ISSN:2385-2011
DOI:10.1177/15910199251342841

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