Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study
Authors: Salim Hamza Adel , Yedavalli Vivek , Musmar Basel , Adeeb Nimer , Essibayi Muhammed Amir , Naamani Kareem El , Henninger Nils , Sundararajan Sri Hari , Kühn Anna Luisa , Khalife Jane , Ghozy Sherief , Scarcia Luca , Tan Benjamin Y.Q. , Pulli Benjamin , Heit Jeremy J. , Regenhardt Robert W. , Cancelliere Nicole M. , Bernstock Joshua D. , Rouchaud Aymeric , Fiehler Jens , Sheth Sunil , Puri Ajit S. , Dyzmann Christian , Colasurdo Marco , Barreau Xavier , Renieri Leonardo , Filipe João Pedro , Harker Pablo , Radu Razvan Alexandru , Marotta Thomas R. , Spears Julian , Ota Takahiro , Mowla Ashkan , Jabbour Pascal , Biswas Arundhati , Clarençon Frédéric , Siegler James E. , Nguyen Thanh N. , Varela Ricardo , Baker Amanda , Altschul David , Gonzalez Nestor R. , Möhlenbruch Markus A. , Costalat Vincent , Gory Benjamin , Stracke Christian Paul , Aziz-Sultan Mohammad Ali , Hecker Constantin , Shaikh Hamza , Liebeskind David S. , Pedicelli Alessandro , Alexandre Andrea M. , Tancredi Illario , Faizy Tobias D. , Kalsoum Erwah , Lubicz Boris , Patel Aman B. , Pereira Vitor Mendes , Guenego Adrien , Dmytriw Adam A. ,   the MAD MT Investigators
Published: September 2024

Background and Purpose The management of acute ischemic stroke (AIS) due to distal medium vessel occlusion (DMVO) remains uncertain, particularly in comparing the effectiveness of intravenous thrombolysis (IVT) plus mechanical thrombectomy (MT) versus IVT alone. This study aimed to evaluate the safety and efficacy in DMVO patients treated with either MT-IVT or IVT alone.Methods This multinational study analyzed data from 37 centers across North America, Asia, and Europe. Patients with AIS due to DMVO were included, with data collected from September 2017 to July 2023. The primary outcome was functional independence, with secondary outcomes including mortality and safety measures such as types of intracerebral hemorrhage.Results The study involved 1,057 patients before matching, and 640 patients post-matching. Functional outcomes at 90 days showed no significant difference between groups in achieving good functional recovery (modified Rankin Scale 0–1 and 0–2), with adjusted odds ratios (OR) of 1.21 (95% confidence interval [CI] 0.81 to 1.79; <i>P</i>=0.35) and 1.00 (95% CI 0.66 to 1.51; <i>P</i>>0.99), respectively. Mortality rates at 90 days were similar between the two groups (OR 0.75, 95% CI 0.44 to 1.29; <i>P</i>=0.30). The incidence of symptomatic intracerebral hemorrhage was comparable, but any type of intracranial hemorrhage was significantly higher in the MT-IVT group (OR 0.43, 95% CI 0.29 to 0.63; <i>P</i><0.001).Conclusion The results of this study indicate that while MT-IVT and IVT alone show similar functional and mortality outcomes in DMVO patients, MT-IVT presents a higher risk of hemorrhagic complications, thus MT-IVT may not routinely offer additional benefits over IVT alone for all DMVO stroke patients. Further prospective randomized trials are needed to identify patient subgroups most likely to benefit from MT-IVT treatment in DMVO.