{
  "abstract": "Introduction Three randomized trials observed that endovascular treatment (EVT) for acute ischemic stroke due to distal medium-vessel occlusion (DMVO) within 12h did not lead to better outcomes than usual care. Furthermore, these trials did not identify any variable associated with a treatment effect modification that may potentially help to guide treatment decision-making. Hence, a controverse discussion persists particularly regarding EVT for M2 occlusions.Aim of Study To identify baseline variables in acute M2 occlusions associated with treatment effect modification.Method Multicenter retrospective cohort study including ischemic stroke patients with acute M2 occlusion triaged by multimodal-CT undergoing EVT. To test for treatment effect modification, interaction terms for all available baseline variables and recanalization were tested in multivariable logistic regression analysis. Primary and secondary endpoints were functional independence (mRS≤2) and penumbra salvage volume (PSV) based on the difference of initial penumbra and final infarct volume.Results 147 patients were included, of which 85 (58%) exhibited successful vessel recanalization. Among all available variables, only NIHSS showed a significant interaction with recanalization suggesting a heterogenous treatment effect (aOR:0.17,95%CI:0.013–0.33,p=0.03). There was a significant treatment effect of recanalization on functional outcome and PSV in patients with NIHSS>10 (22.1%,p=0.02; 45ml,p=0.03), but no significant effect in patients with NIHSS≤10 (0.6%,p=0.96; 23.5ml,p=0.2).Conclusion The benefit of EVT in patients with acute M2 occlusion is directly linked to clinical severity. Considering the neutral to negative results from the recently published trials on distal occlusion EVT, the NIHSS might be a decisive variable to select M2 patients for treatment.Conflict of Interest Yes Personal fees from Acandis, Grant from DFG, Grant from ASNR",
  "authors": [
    {
      "affiliations": [
        "MSH Medical School Hamburg, Helios Kliniken Schwerin, Hamburg, Germany",
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Gabriel Broocks"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Helge Kniep"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Lukas Meyer"
    },
    {
      "affiliations": [
        "University Muenster, Münster, Germany"
      ],
      "name": "Christian Paul Stracke"
    },
    {
      "affiliations": [
        "Stanford University, Stanford, USA"
      ],
      "name": "Greg Albers"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Jens Fiehler"
    },
    {
      "affiliations": [
        "Stanford University, Stanford, USA"
      ],
      "name": "Jeremy Heit"
    },
    {
      "affiliations": [
        "University Muenster, Münster, Germany"
      ],
      "name": "Tobias Faizy"
    }
  ],
  "title": "A250 Refining selection for thrombectomy in M2 occlusion stroke: role of treatment effect modifiers",
  "uid": "a0648a6d-f4cd-5702-a3a3-538a59796119"
}