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  • Title: Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study.
    Author: 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 GroupFrom the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)..
    Journal: Radiology; 2023 Apr; 307(2):e220229. PubMed ID: 36786705.
    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. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zhu and Wang in this issue.
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