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, Vol. 307, No. 2, e220229, 04.2023, p. e220229.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -