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Background <p>The efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) for distal, medium vessel occlusions (DMVO) is not well established. This study investigates whether IVT impacts outcomes in DMVO patients, particularly in those with unsuccessful or partial recanalization after MT.</p> Methods <p>We conducted a&#xa0;retrospective, multicenter study using data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. The study population included AIS patients with DMVO in the M2, M3, and M4 segments of the MCA, treated with or without IVT followed by MT and a&#xa0;final modified Thrombolysis in Cerebral Infarction (mTICI) score of&#xa0;0, 1, or 2a. The primary outcome was functional independence, assessed by the 90-day modified Rankin Scale (mRS) of 0–1 or 0–2.</p> Results <p>The study comprised 210 patients with final mTICI&#xa0;0 to 2a, with 130 undergoing MT alone and&#xa0;80 receiving IVT followed by MT. Logistic regression analysis revealed no significant differences in clinical outcomes between groups. The odds ratios (ORs) for achieving a&#xa0;90-day mRS of 0–1 and 0–2 were 1.55 (95% CI 0.62 to 3.87; <i>p</i> = 0.34) and 1.55 (95% CI 0.72 to 3.37; <i>p</i> = 0.26), respectively. The odds of symptomatic intracerebral hemorrhage (sICH) were similar between groups (OR 0.64, 95% CI 0.28 to 1.47; <i>p</i> = 0.29), as were the odds of intracranial hemorrhage (ICH) of any type (OR 1.39, 95% CI 0.71 to 2.73; <i>p</i> = 0.34).</p> Conclusions <p>In AIS patients with DMVO and unsuccessful or partial recanalization after MT, IVT did not significantly improve clinical outcomes. Additionally, IVT did not increase the risk of hemorrhagic complications. These findings suggest that while IVT preceding MT is safe in this context, it may not improve outcomes for patients with unsuccessful MT.</p>

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Intravenous Thrombolysis in Distal Medium Middle Cerebral Artery Occlusion Patients with Unsuccessful Mechanical Reperfusion

  • 期刊论文

  • 发表日期：

    2025年11月25日

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  • Hamza Adel Salim,
  • Benjamin Pulli,
  • Vivek Yedavalli,
  • Dhairya Lakhani,
  • Orabi Hajjeh,
  • Basel Musmar,
  • Nimer Adeeb,
  • Fathi Milhem,
  • Davide Simonato,
  • Yan-Lin Li,
  • Muhammed Amir Essibayi,
  • Nils Henninger,
  • Sri Hari Sundararajan,
  • Anna Luisa Kühn,
  • Jane Khalife,
  • Sherief Ghozy,
  • Luca Scarcia,
  • Leonard L. Yeo,
  • Benjamin Y. Q. Tan,
  • Robert W. Regenhardt,
  • Aymeric Rouchaud,
  • Jens Fiehler,
  • Sunil Sheth,
  • Ajit S. Puri,
  • Christian Dyzmann,
  • Marco Colasurdo,
  • Leonardo Renieri,
  • João Pedro Filipe,
  • Pablo Harker,
  • Răzvan Alexandru Radu,
  • Mohamad Abdalkader,
  • Piers Klein,
  • Takahiro Ota,
  • Ashkan Mowla,
  • Kareem El Naamani,
  • Pascal Jabbour,
  • Arundhati Biswas,
  • Frédéric Clarençon,
  • James E. Siegler,
  • Thanh N. Nguyen,
  • Ricardo Varela,
  • Amanda Baker,
  • David Altschul,
  • Nestor R. Gonzalez,
  • Markus A. Möhlenbruch,
  • Vincent Costalat,
  • Benjamin Gory,
  • Christian Paul Stracke,
  • Constantin Hecker,
  • Gaultier Marnat,
  • Hamza Shaikh,
  • Christoph J. Griessenauer,
  • David S. Liebeskind,
  • Alessandro Pedicelli,
  • Andrea M. Alexandre,
  • Tobias D. Faizy,
  • Illario Tancredi,
  • Erwah Kalsoum,
  • Boris Lubicz,
  • Vitor Mendes Pereira,
  • Aman B. Patel,
  • Maurizio Fuschi,
  • Max Wintermark,
  • Jeremy J. Heit,
  • Adrien Guenego,
  • Adam A. Dmytriw,
  • Abdelaziz Amllay,
  • Achala Vagal,
  • Adrien ter Schiphorst,
  • Ajith J. Thomas,
  • Anil Gopinathan,
  • Anne Dusart,
  • Carolina Capirossi,
  • Charbel Mounayer,
  • Charlotte Weyland,
  • Cheng-Yang Hsieh,
  • Christopher J. Stapleton,
  • Erwah Kalsoum,
  • Flavio Bellante,
  • Géraud Forestier,
  • Hamza Shaikh,
  • Hugo H. Cuellar-Saenz,
  • Iacopo Valente,
  • Igor Sibon,
  • James D. Rabinov,
  • Jérôme Berge,
  • Jessica Jesser,
  • Juan Carlos Martinez-Gutierrez,
  • Kevin Premat,
  • Lina Chervak,
  • Lukas Meyer,
  • Mahmoud Elhorany,
  • Miguel Quintero-Consuegra,
  • Mohammad Ali Aziz-Sultan,
  • Monika Killer-Oberpfalzer,
  • Peter T Kan,
  • Priyank Khandelwal,
  • Ramanathan Kadirvel,
  • Robert Fahed,
  • Sergio Salazar-Marioni,
  • Shogo Dofuku,
  • Simona Nedelcu,
  • Stavropoula I. Tjoumakaris,
  • Suzana Saleme,
  • Xavier Barreau,
  • Yasmin Aziz

摘要

Background

The efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) for distal, medium vessel occlusions (DMVO) is not well established. This study investigates whether IVT impacts outcomes in DMVO patients, particularly in those with unsuccessful or partial recanalization after MT.

Methods

We conducted a retrospective, multicenter study using data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. The study population included AIS patients with DMVO in the M2, M3, and M4 segments of the MCA, treated with or without IVT followed by MT and a final modified Thrombolysis in Cerebral Infarction (mTICI) score of 0, 1, or 2a. The primary outcome was functional independence, assessed by the 90-day modified Rankin Scale (mRS) of 0–1 or 0–2.

Results

The study comprised 210 patients with final mTICI 0 to 2a, with 130 undergoing MT alone and 80 receiving IVT followed by MT. Logistic regression analysis revealed no significant differences in clinical outcomes between groups. The odds ratios (ORs) for achieving a 90-day mRS of 0–1 and 0–2 were 1.55 (95% CI 0.62 to 3.87; p = 0.34) and 1.55 (95% CI 0.72 to 3.37; p = 0.26), respectively. The odds of symptomatic intracerebral hemorrhage (sICH) were similar between groups (OR 0.64, 95% CI 0.28 to 1.47; p = 0.29), as were the odds of intracranial hemorrhage (ICH) of any type (OR 1.39, 95% CI 0.71 to 2.73; p = 0.34).

Conclusions

In AIS patients with DMVO and unsuccessful or partial recanalization after MT, IVT did not significantly improve clinical outcomes. Additionally, IVT did not increase the risk of hemorrhagic complications. These findings suggest that while IVT preceding MT is safe in this context, it may not improve outcomes for patients with unsuccessful MT.