Mechanical thrombectomy in minor stroke due to isolated M2 occlusion: a multicenter retrospective matched analysis

Alexandre, Andrea; Colò, Francesca; Brunetti, Valerio; Valente, Iacopo; Frisullo, Giovanni; Pedicelli, Alessandro; Scarcia, Luca; Rollo, Claudia; Falcou, Anne; Milonia, Luca; Andrighetti, Marco; Piano, Mariangela; Macera, Antonio; Commodaro, Christian; Ruggiero, Maria; Ros, Valerio Da; Bellini, Luigi; Lazzarotti, G; Cosottini, Mirco; Caragliano, Armando A; Vinci, Sergio Lucio; Gabrieli, Joseph; Causin, Francesco; Panni, Pietro; Roveri, Luisa; Limbucci, Nicola; Arba, Francesco; Pileggi, Marco; Bianco, Giovanni; Romano, Daniele; Diana, Francesco; Semeraro, Vittorio; Burdi, Nicola; Ganimede, Maria Porzia; Lozupone, Emilio; Fasano, Antonio; Lafe, Elvis; Cavallini, Anna; Russo, Riccardo; Bergui, Mauro; Calabresi, Paolo; Marca, Giacomo Della; Broccolini, Aldobrando

doi:10.1136/jnis-2022-019557

Cited by 21 publications

(14 citation statements)

References 31 publications

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“…Although with some limits due to the ischemic side, higher NIHSS reflects larger ischemic tissue volume ( 8 ). Given that CC status has been previously associated with the extent of ischemic core ( 3 ), NIHSS may represent a surrogate of it ( 24 ). The association of NIHSS with CC seems consistent across studies, and we found a similar magnitude of the effect of NIHSS on collateral status compared with other studies.…”

Section: Discussionmentioning

confidence: 99%

Determinants of cerebral collateral circulation in acute ischemic stroke due to large vessel occlusion

et al. 2023

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IntroductionCerebral collateral circulation has a central role in ischemic stroke pathophysiology, and it is considered to correlate with infarct size, the success of reperfusion therapies, and clinical outcomes. Our aim was to study the factors influencing the development of collaterals in patients with acute ischemic stroke eligible for endovascular treatment.Materials and methodsWe enrolled patients with acute ischemic stroke and large vessel occlusion of anterior circulation potentially eligible for endovascular treatment. Included patients performed multiphase CT angiography to assess collaterals that were graded by the Menon Grading Score. We investigated the associations between clinical factors and collaterals and tested independent associations with logistic (good vs. poor collaterals) and ordinal (collateral grade grouped, Menon 0–2, 3, 4–5) regression analysis adjusting for age, sex, stroke severity, and onset to CT time (OCTT).ResultsWe included 520 patients, the mean age was 75 (±13.6) years, 215 (41%) were men, and the median (IQR) NIHSS was 17 (11–22). Good collaterals were present in 323 (62%) patients and were associated with lower NIHSS (median 16 vs. 18; p < 0.001) and left hemisphere involvement (60% vs. 45%; p < 0.001), whereas previous stroke/TIA was more frequent in patients with poor collaterals (17 vs. 26%; p = 0.014). These results were confirmed in both logistic and ordinal regression analyses where good collaterals were associated with lower NIHSS (OR = 0.94; 95% CI = 0.91–0.96; cOR = 0.95; 95% CI = 0.92–0.97, respectively) and left hemisphere stroke (OR = 2.24; 95% CI = 1.52–3.28; cOR = 2.11; 95% CI = 1.46–3.05, respectively), while previous stroke/TIA was associated with poor collaterals (OR = 0.57; 95% CI = 0.36–0.90; cOR = 0.61; 95% CI = 0.40–0.94, respectively). Vascular risk factors, demographics, and pre-stroke treatments did not influence the collateral score.DiscussionThe results of our study suggest that risk factors and demographics do not influence the development of collateral circles, except for a negative relation with previous ischemic events. We confirm an already reported observation of a possible protective effect of collaterals on tissue damage assuming NIHSS as its surrogate. The association between left hemispheric stroke and better collaterals deserves to be further explored. Further efforts are needed to identify the factors that favor the development of collaterals.

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Section: Discussionmentioning

confidence: 99%

Determinants of cerebral collateral circulation in acute ischemic stroke due to large vessel occlusion

et al. 2023

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“…After full-text reading, 20 articles were excluded for the following reasons: (1) the medical treatment group was not relevant, (2) the mild stroke was not relevant, (3) patients with posterior circulation occlusion were included, and (4) the outcomes of the EVT and medical treatment groups were missing. Finally, 14 articles12 18–20 27–36 were found to be eligible, with 1819 and 2516 patients treated with EVT and medical treatment, respectively (figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 shows the details of the design and baseline characteristics of each included study. Furthermore, PS-based methods adjusted analysis was reported in 10 studies,18–20 28 29 31–35 whose main characteristics are summarized in online supplemental table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Sensitivity analysis was conducted to determine the influence of medical treatment including rescue EVT. A pooled analysis was then performed by omitting five studies19 20 28 29 36 that reported medical treatment including rescue EVT. The sensitivity analysis revealed that the main results of this meta-analysis were statistically stable and reliable (online supplemental table 4).…”

Section: Resultsmentioning

confidence: 99%

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Endovascular treatment versus medical management for mild stroke with acute anterior circulation large vessel occlusion: a meta-analysis

Qin

Zhang

Liang

et al. 2023

J NeuroIntervent Surg

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BackgroundThe effectiveness of endovascular treatment (EVT) in patients with mild stroke (National Institutes of Health Stroke Scale score ≤5) and acute anterior circulation large vessel occlusion (AACLVO) remains unknown.ObjectiveTo conduct a meta-analysis to compare the efficacy and safety of EVT in patients with mild stroke and AACLVO.MethodsEMBASE, Cochrane Library, PubMed, and Clinicaltrials.gov databases were searched until October 2022. Both retrospective and prospective studies which compared the clinical outcomes between EVT and medical treatment were included. ORs and 95% confidence intervals (CIs) for excellent and favorable functional outcomes, symptomatic intracranial hemorrhage (ICH), and mortality were pooled using a random-effects model. A propensity score (PS)-based methods adjusted analysis was also performed.Results4335 patients from 14 studies were included. In patients with mild stroke and AACLVO, EVT presented no marked differences in excellent and favorable functional outcomes and mortality compared with medical treatment. A higher risk of symptomatic ICH (OR=2.79; 95% CI 1.49 to 5.24; P=0.001) was observed with EVT. Subgroup analysis revealed that EVT had potential benefit for proximal occlusions with excellent functional outcomes (OR=1.68; 95% CI 1.01 to 2.82; P=0.05). Similar results were observed when PS-based methods adjusted analysis was used.ConclusionEVT did not significantly benefit clinical functional outcomes in comparison with medical treatment in patients with mild stroke and AACLVO. However, it may improve functional outcomes when treating patients with proximal occlusion, despite being associated with an increased risk of symptomatic ICH. Stronger evidence from ongoing randomized controlled trials is required.

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“…Alexandre et al showed in their study that early MT is likely superior to BMT in patients with LVO, even if their NIHSS on admission is low (≤ 5) 24 . However, this is not necessarily the same for DMVO, as another study showed no benefit of early MT compared with BMT in patients with NIHSS ≤ 5 and isolated M2 occlusions 25 . In our study, subgroup analysis could not be performed to address this issue because of the limited number of patients.…”

Section: Discussionmentioning

confidence: 95%

Mechanical thrombectomy of distal cerebral vessel occlusions of the anterior circulation

Sepp

Petzsche

Zarth

et al. 2023

Sci Rep

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Mechanical thrombectomy (MT) is frequently performed for distal medium vessel occlusions (DMVO) of the anterior circulation in acute stroke patients. However, evidence for its clinical benefit remains scarce. In this study, we aim to investigate clinical course and safety outcomes of MT in comparison to standard medical therapy (SMT) in DMVO. This single-center retrospective observational study included 138 consecutive patients treated for DMVO of the anterior circulation between 2015 and 2021. To reduce the risk of selection bias, propensity score matching (PSM) of patients with MT versus SMT was performed for the covariates NIHSS and mRS at admission. Out of all 138 patients, 48 (34.8%) received MT and 90 (65.2%) received SMT only. Overall, patients treated with MT showed significantly higher NIHSS and mRS scores at admission. Post 1:1 PSM, there was a trend toward a better NIHSS improvement in patients with MT (median 4 vs. 1, P = 0.1). No significant differences were observed in the occurrence of symptomatic intracranial hemorrhage or mortality between the groups before and after PSM. A subgroup analysis showed significantly higher NIHSS improvement (median 5 versus 1, P = 0.01) for patients with successful MT (≥ mTICI 2b). Mechanical thrombectomy for distal medium vessel occlusions (DMVO) in the anterior circulation appeared safe and feasible. Successful recanalization was associated with clinical improvement. Larger, multi-center, randomized-controlled trials are required to corroborate these findings.

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Mechanical thrombectomy in minor stroke due to isolated M2 occlusion: a multicenter retrospective matched analysis

Cited by 21 publications

References 31 publications

Determinants of cerebral collateral circulation in acute ischemic stroke due to large vessel occlusion

Determinants of cerebral collateral circulation in acute ischemic stroke due to large vessel occlusion

Endovascular treatment versus medical management for mild stroke with acute anterior circulation large vessel occlusion: a meta-analysis

Mechanical thrombectomy of distal cerebral vessel occlusions of the anterior circulation

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