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oai:recercat.cat:11351/138872025-10-24T10:37:46Zcom_2072_378070com_2072_378040col_2072_378092

Safety and efficacy of mechanical thrombectomy in distal medium vessel occlusions: Experience and real-world data from an Italian stroke hub centre Alessiani, Michele Bonura, Adriano Iaccarino, Gianmarco Rossi, Sergio Soeren MANGIARDI, MARILENA Bravi, Maria Cristina Institut Català de la Salut [Alessiani M] Department of Neurology, Santa Maria Goretti Hospital, Latina, Italy. [Bonura A] Unitat d’Ictus, Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Iaccarino G] BarcelonaBeta Brain Research Center and Department of Neurology, Hospital del Mar Research Institute, Barcelona, Spain. [Rossi SS] Deparment of Neurology, IRCSS Policlinico San Donato, San Donato Milanese, Italy. [Mangiardi M, Bravi MC] Head, Neck and Neuroscience Department, Stroke Unit, San Camillo-Forlanini Hospital, Rome, Italy Vall d'Hebron Barcelona Hospital Campus Avaluació de resultats (Assistència sanitària) Malalties cerebrovasculars - Tractament Teràpia trombolítica Vasos sanguinis - Cirurgia ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Thrombectomy ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Drug Therapy::Thrombolytic Therapy DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke Other subheadings::Other subheadings::/therapy TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::trombectomía TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::farmacoterapia::tratamiento trombolítico ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular Otros calificadores::Otros calificadores::/terapia Distal medium vessel occlusion; Ischemic stroke; Mechanical thrombectomy Oclusión del vaso mediano distal; Ictus isquémico; Trombectomía mecánica Oclusió del vas mitjà distal; Ictus isquèmic; Trombectomia mecànica Background and purpose: Distal-medium vessel occlusions (DMVOs) contribute to approximately 25-40 % of cases of ischemic stroke. Intravenous thrombolysis (IVT) achieved a complete recanalization in <50 % of cases. Observational studies have demonstrated comparable efficacy and safety of mechanical thrombectomy (MT) in DMVOs compared to LVOs. Recently published RCTs have shown that MT plus best medical therapy in DMVOs does not improve the outcome compared to best medical therapy alone METHODS: We conducted a retrospective observational study involving patients with acute ischemic stroke (AIS) and primary or secondary DMVO according to literature classification. DMVOs were defined as occlusion in the A2, A3, distal M2 or its single branch, M3, P2, P3, PICA, SCA and AICA. The primary endpoint was to evaluate the safety and efficacy of MT alone in DMVOs compared to IVT. Efficacy was assessed by considering the change in NIHSS from admission to discharge, 3 months Modified Rankin Scale (mRS), 3 months mortality rate and recanalization rate. Safety was assessed based on haemorrhagic transformation and procedural complications. As a secondary endpoint we compared primary and secondary DMVO to highlight any differences. Results: In primary plus secondary DMVO after propensity score analysis there were no statistically significant differences in efficacy and safety between MT and IVT though a positive trend for NIHSS reduction in the MT group. Sub-analysis of primary DMVO did not show significant differences between the two groups. MT group achieved an excellent recanalization rate with mTICI ≥2b in 95 % of cases and no procedural complications occurred. Conclusions: MT in DMVOs showed an excellent recanalization rate and few procedural complications. New RCTs are needed to compare the efficacy and safety of MT alone versus IVT alone in primary and secondary DMVOs separately. 2025-10-20T08:56:39Z 2025-10-20T08:56:39Z 2025-06 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Alessiani M, Bonura A, Iaccarino G, Rossi SS, Mangiardi M, Bravi MC, et al. Safety and efficacy of mechanical thrombectomy in distal medium vessel occlusions: Experience and real-world data from an Italian stroke hub centre. J Stroke Cerebrovasc Dis. 2025 Jun;34(6):108321. 1052-3057 http://hdl.handle.net/11351/13887 10.1016/j.jstrokecerebrovasdis.2025.108321 40239825 001477036400001 http://hdl.handle.net/11351/13887 eng Journal of Stroke and Cerebrovascular Diseases;34(6) https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108321 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess application/pdf Elsevier Scientia