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

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Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study. / Meyer, Lukas; Stracke, Paul; Broocks, Gabriel; Elsharkawy, Mohamed; Sporns, Peter; Piechowiak, Eike I; Kaesmacher, Johannes; Maegerlein, Christian; Hernandez Petzsche, Moritz Roman; Zimmermann, Hanna; Naziri, Weis; Abdullayev, Nuran; Kabbasch, Christoph; Diamandis, Elie; Thormann, Maximilian; Maus, Volker; Fischer, Sebastian; Möhlenbruch, Markus; Weyland, Charlotte S; Ernst, Marielle; Jamous, Ala; Meila, Dan; Miszczuk, Milena; Siebert, Eberhard; Lowens, Stephan; Krause, Lars Udo; Yeo, Leonard; Tan, Benjamin; Gopinathan, Anil; Arenillas-Lara, Juan F; Navia, Pedro; Raz, Eytan; Shapiro, Maksim; Arnberg, Fabian; Zeleňák, Kamil; Martínez-Galdámez, Mario; Alexandrou, Maria; Kastrup, Andreas; Papanagiotou, Panagiotis; Kemmling, André; Dorn, Franziska; Psychogios, Marios; Andersson, Tommy; Chapot, René; Fiehler, Jens; Hanning, Uta; TOPMOST Study Group.

in: RADIOLOGY, Jahrgang 307, Nr. 2, e220229, 04.2023, S. e220229.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Meyer, L, Stracke, P, Broocks, G, Elsharkawy, M, Sporns, P, Piechowiak, EI, Kaesmacher, J, Maegerlein, C, Hernandez Petzsche, MR, Zimmermann, H, Naziri, W, Abdullayev, N, Kabbasch, C, Diamandis, E, Thormann, M, Maus, V, Fischer, S, Möhlenbruch, M, Weyland, CS, Ernst, M, Jamous, A, Meila, D, Miszczuk, M, Siebert, E, Lowens, S, Krause, LU, Yeo, L, Tan, B, Gopinathan, A, Arenillas-Lara, JF, Navia, P, Raz, E, Shapiro, M, Arnberg, F, Zeleňák, K, Martínez-Galdámez, M, Alexandrou, M, Kastrup, A, Papanagiotou, P, Kemmling, A, Dorn, F, Psychogios, M, Andersson, T, Chapot, R, Fiehler, J, Hanning, U & TOPMOST Study Group 2023, 'Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study', RADIOLOGY, Jg. 307, Nr. 2, e220229, S. e220229. https://doi.org/10.1148/radiol.220229

APA

Meyer, L., Stracke, P., Broocks, G., Elsharkawy, M., Sporns, P., Piechowiak, E. I., Kaesmacher, J., Maegerlein, C., Hernandez Petzsche, M. R., Zimmermann, H., Naziri, W., Abdullayev, N., Kabbasch, C., Diamandis, E., Thormann, M., Maus, V., Fischer, S., Möhlenbruch, M., Weyland, C. S., ... TOPMOST Study Group (2023). Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study. RADIOLOGY, 307(2), e220229. [e220229]. https://doi.org/10.1148/radiol.220229

Vancouver

Meyer L, Stracke P, Broocks G, Elsharkawy M, Sporns P, Piechowiak EI et al. Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study. RADIOLOGY. 2023 Apr;307(2):e220229. e220229. https://doi.org/10.1148/radiol.220229

Bibtex

@article{0ef97a6ae62e4fe28e3b33788a900d39,
title = "Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study",
abstract = "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. {\textcopyright} RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zhu and Wang in this issue.",
author = "Lukas Meyer and Paul Stracke and Gabriel Broocks and Mohamed Elsharkawy and Peter Sporns and Piechowiak, {Eike I} and Johannes Kaesmacher and Christian Maegerlein and {Hernandez Petzsche}, {Moritz Roman} and Hanna Zimmermann and Weis Naziri and Nuran Abdullayev and Christoph Kabbasch and Elie Diamandis and Maximilian Thormann and Volker Maus and Sebastian Fischer and Markus M{\"o}hlenbruch and Weyland, {Charlotte S} and Marielle Ernst and Ala Jamous and Dan Meila and Milena Miszczuk and Eberhard Siebert and Stephan Lowens and Krause, {Lars Udo} and Leonard Yeo and Benjamin Tan and Anil Gopinathan and Arenillas-Lara, {Juan F} and Pedro Navia and Eytan Raz and Maksim Shapiro and Fabian Arnberg and Kamil Zele{\v n}{\'a}k and Mario Mart{\'i}nez-Gald{\'a}mez and Maria Alexandrou and Andreas Kastrup and Panagiotis Papanagiotou and Andr{\'e} Kemmling and Franziska Dorn and Marios Psychogios and Tommy Andersson and Ren{\'e} Chapot and Jens Fiehler and Uta Hanning and {TOPMOST Study Group}",
year = "2023",
month = apr,
doi = "10.1148/radiol.220229",
language = "English",
volume = "307",
pages = "e220229",
journal = "RADIOLOGY",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "2",

}

RIS

TY - JOUR

T1 - Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study

AU - Meyer, Lukas

AU - Stracke, Paul

AU - Broocks, Gabriel

AU - Elsharkawy, Mohamed

AU - Sporns, Peter

AU - Piechowiak, Eike I

AU - Kaesmacher, Johannes

AU - Maegerlein, Christian

AU - Hernandez Petzsche, Moritz Roman

AU - Zimmermann, Hanna

AU - Naziri, Weis

AU - Abdullayev, Nuran

AU - Kabbasch, Christoph

AU - Diamandis, Elie

AU - Thormann, Maximilian

AU - Maus, Volker

AU - Fischer, Sebastian

AU - Möhlenbruch, Markus

AU - Weyland, Charlotte S

AU - Ernst, Marielle

AU - Jamous, Ala

AU - Meila, Dan

AU - Miszczuk, Milena

AU - Siebert, Eberhard

AU - Lowens, Stephan

AU - Krause, Lars Udo

AU - Yeo, Leonard

AU - Tan, Benjamin

AU - Gopinathan, Anil

AU - Arenillas-Lara, Juan F

AU - Navia, Pedro

AU - Raz, Eytan

AU - Shapiro, Maksim

AU - Arnberg, Fabian

AU - Zeleňák, Kamil

AU - Martínez-Galdámez, Mario

AU - Alexandrou, Maria

AU - Kastrup, Andreas

AU - Papanagiotou, Panagiotis

AU - Kemmling, André

AU - Dorn, Franziska

AU - Psychogios, Marios

AU - Andersson, Tommy

AU - Chapot, René

AU - Fiehler, Jens

AU - Hanning, Uta

AU - TOPMOST Study Group

PY - 2023/4

Y1 - 2023/4

N2 - 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. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zhu and Wang in this issue.

AB - 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. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zhu and Wang in this issue.

U2 - 10.1148/radiol.220229

DO - 10.1148/radiol.220229

M3 - SCORING: Journal article

C2 - 36786705

VL - 307

SP - e220229

JO - RADIOLOGY

JF - RADIOLOGY

SN - 0033-8419

IS - 2

M1 - e220229

ER -