Cyril Dargazanli1, Caroline Arquizan2, Benjamin Gory2, Arturo Consoli2, Julien Labreuche2, Hocine Redjem2, Omer Eker2, Jean-Pierre Decroix2, Astrid Corlobé2, Isabelle Mourand2, Nicolas Gaillard2, Xavier Ayrignac2, Mahmoud Charif2, Alain Duhamel2, Paul-Emile Labeyrie2, Carlos Riquelme2, Gabriele Ciccio2, Stanislas Smajda2, Jean-Philippe Desilles2, Grégory Gascou2, Pierre-Henri Lefèvre2, Daniel Mantilla-García2, Federico Cagnazzo2, Oguzhan Coskun2, Mikael Mazighi2, Roberto Riva2, Frédéric Bourdain2, Pierre Labauge2, Georges Rodesch2, Michael Obadia2, Alain Bonafé2, Francis Turjman2, Vincent Costalat2, Michel Piotin2, Raphaël Blanc2, Bertrand Lapergue2. 1. From the Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France (C.D., O.E., C.R., G.G., P.-H.L., D.M.-G., F.C., A.B., V.C.); Department of Neurology, Gui de Chauliac Hospital, Montpellier, France (C.A., A.C., I.M., N.G., X.A., M.C., P.L.); Department of Interventional Neuroradiology, Pierre Wertheimer Hospital, Lyon-Bron, France (B.G., P.-E.L., R.R., F.T.); Department of Interventional Neuroradiology (A.C., O.C., G.R.) and Department of Neurology (J.-P.D., F.B., B.L.), Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France; Univ. Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, France (J.L., A.D.); and Department of Interventional Neuroradiology (H.R., G.C., S.S., J.-P.D., M.M., M.P., R.B.) and Department of Neurology (M.O.), Rothschild Foundation, Paris, France. c.dargazanli@gmail.com. 2. From the Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France (C.D., O.E., C.R., G.G., P.-H.L., D.M.-G., F.C., A.B., V.C.); Department of Neurology, Gui de Chauliac Hospital, Montpellier, France (C.A., A.C., I.M., N.G., X.A., M.C., P.L.); Department of Interventional Neuroradiology, Pierre Wertheimer Hospital, Lyon-Bron, France (B.G., P.-E.L., R.R., F.T.); Department of Interventional Neuroradiology (A.C., O.C., G.R.) and Department of Neurology (J.-P.D., F.B., B.L.), Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France; Univ. Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, France (J.L., A.D.); and Department of Interventional Neuroradiology (H.R., G.C., S.S., J.-P.D., M.M., M.P., R.B.) and Department of Neurology (M.O.), Rothschild Foundation, Paris, France.
Abstract
BACKGROUND AND PURPOSE: Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. The effectiveness of mechanical thrombectomy (MT) in the subgroup of minor stroke with LVO in the anterior circulation is still open to debate. Data about MT in this subgroup of patients are sparse, and their optimal management has not yet been defined. The purpose of this multicenter cohort study was to evaluate the effectiveness of MT in patients experiencing acute ischemic stroke (AIS) because of LVO in the anterior circulation, presenting with minor-to-mild stroke symptoms (National Institutes of Health Stroke Scale score of <8). METHODS: Multicenter cohort study involving 4 comprehensive stroke centers having 2 therapeutic approaches (urgent thrombectomy associated with best medical treatment [BMT] versus BMT first and MT if worsening occurs) about management of patients with minor and mild acute ischemic stroke harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0 to 1 at 3 months. RESULTS: Three hundred one patients were included, 170 with urgent MT associated with BMT, and 131 with BMT alone as first-line treatment. Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.0%) in the medical group had rescue MT because of neurological worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the 2 groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size. CONCLUSIONS: Minor-to-mild stroke patients with LVO achieved excellent and favorable functional outcomes at 3 months in similar proportions between urgent MT versus delayed MT associated with BMT. There is thus an urgent need for randomized trials to define the effectiveness of MT in this patient subgroup.
BACKGROUND AND PURPOSE: Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. The effectiveness of mechanical thrombectomy (MT) in the subgroup of minor stroke with LVO in the anterior circulation is still open to debate. Data about MT in this subgroup of patients are sparse, and their optimal management has not yet been defined. The purpose of this multicenter cohort study was to evaluate the effectiveness of MT in patients experiencing acute ischemic stroke (AIS) because of LVO in the anterior circulation, presenting with minor-to-mild stroke symptoms (National Institutes of Health Stroke Scale score of <8). METHODS: Multicenter cohort study involving 4 comprehensive stroke centers having 2 therapeutic approaches (urgent thrombectomy associated with best medical treatment [BMT] versus BMT first and MT if worsening occurs) about management of patients with minor and mild acute ischemic stroke harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0 to 1 at 3 months. RESULTS: Three hundred one patients were included, 170 with urgent MT associated with BMT, and 131 with BMT alone as first-line treatment. Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.0%) in the medical group had rescue MT because of neurological worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the 2 groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size. CONCLUSIONS: Minor-to-mild strokepatients with LVO achieved excellent and favorable functional outcomes at 3 months in similar proportions between urgent MT versus delayed MT associated with BMT. There is thus an urgent need for randomized trials to define the effectiveness of MT in this patient subgroup.
Authors: Andrea Maria Alexandre; Iacopo Valente; Alessandro Pedicelli; Angelo Maria Pezzullo; Francesca Colò; Luca Scarcia; Andrea Romi; Mariangela Piano; Antonio Macera; Joseph Domenico Gabrieli; Giacomo Cester; Antonio Armando Caragliano; Sergio Lucio Vinci; Maria Ruggiero; Christian Commodaro; Andrea Saletti; Guido Andrea Lazzarotti; Mirco Cosottini; Valerio Da Ros; Luigi Bellini; Emilio Lozupone; Adriana Paladini; Valerio Brunetti; Roberta Morosetti; Giovanni Frisullo; Paolo Calabresi; Giacomo Della Marca; Aldobrando Broccolini Journal: Neurol Sci Date: 2021-11-29 Impact factor: 3.830
Authors: Amrou Sarraj; Ameer Hassan; Sean I Savitz; James C Grotta; Chunyan Cai; Kaushik N Parsha; Christine M Farrell; Bita Imam; Clark W Sitton; Sujan T Reddy; Haris Kamal; Nitin Goyal; Lucas Elijovich; Katelin Reishus; Rashi Krishnan; Navdeep Sangha; Abel Wu; Renata Costa; Ruqayyah Malik; Osman Mir; Rashedul Hasan; Lindsay M Snodgrass; Manuel Requena; Dion Graybeal; Michael Abraham; Michael Chen; Louise D McCullough; Marc Ribo Journal: Stroke Date: 2018-10 Impact factor: 7.914
Authors: Nitin Goyal; Georgios Tsivgoulis; Konark Malhotra; Muhammad F Ishfaq; Abhi Pandhi; Michael T Frohler; Alejandro M Spiotta; Mohammad Anadani; Marios Psychogios; Volker Maus; Adnan Siddiqui; Muhammad Waqas; Peter D Schellinger; Marcel Groen; Christos Krogias; Daniel Richter; Maher Saqqur; Pablo Garcia-Bermejo; Maxim Mokin; Ronen Leker; Jose E Cohen; Aristeidis H Katsanos; Georgios Magoufis; Klearchos Psychogios; Vasileios Lioutas; Meg VanNostrand; Vijay K Sharma; Maurizio Paciaroni; Alexandros Rentzos; Hazem Shoirah; J Mocco; Christopher Nickele; Violiza Inoa; Daniel Hoit; Lucas Elijovich; Andrei V Alexandrov; Adam S Arthur Journal: JAMA Neurol Date: 2020-01-01 Impact factor: 18.302
Authors: Ondrej Volny; Charlotte Zerna; Ales Tomek; Michal Bar; Miloslav Rocek; Radek Padr; Filip Cihlar; Miroslava Nevsimalova; Lubomir Jurak; Roman Havlicek; Martin Kovar; Petr Sevcik; Vladimir Rohan; Jan Fiksa; David Cernik; Rene Jura; Daniel Vaclavik; Petra Cimflova; Josep Puig; Dar Dowlatshahi; Alexander V Khaw; Enrico Fainardi; Mohamed Najm; Andrew M Demchuk; Bijoy K Menon; Robert Mikulik; Michael D Hill Journal: Neurology Date: 2020-09-28 Impact factor: 9.910