{
  "abstract": "Background Current randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown.Methods This was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. Only patients with occlusion of the distal branches (M2 and M3) of the middle cerebral artery territory were included. Unsuccessful MT was defined as a modified Thrombolysis in Cerebral Infarction score of 0–2a. Propensity score matching was used to control for confounders. The primary outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days after treatment. Multivariable regression analysis was used to assess factors associated with the primary outcome.Results Of 2903 patients screened for eligibility, 532 patients were analyzed (266 per group) after propensity score matching. The MM group had superior functional outcomes, with 32% achieving mRS 0–1 at 90 days compared with 21% in the MT group (P=0.011). Patients in the MM group also had significantly lower rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 16%, P<0.001) and any hemorrhage (18% vs 48%, P<0.001). On multivariable regression, unsuccessful MT was associated with reduced odds of functional independence (OR 0.50, 95% CI 0.29 to 0.85, P=0.011) and increased odds of sICH (OR 4.32, 95% CI 1.84 to 10.10, P<0.001). Mortality rates were similar between groups (27% in MM vs 29% in MT, P=0.73).Conclusion Unsuccessful MT for MeVO was linked to worse outcomes than best MM. These findings highlight the risks of prolonged attempts and emphasize the importance of efficient procedural decision-making to reduce complications and improve patient outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany"
      ],
      "name": "Tobias D Faizy"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Vivek Yedavalli"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA",
        "Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA"
      ],
      "name": "Hamza Adel Salim"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA"
      ],
      "name": "Dhairya A Lakhani"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA"
      ],
      "name": "Basel Musmar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA, Louisiana, USA"
      ],
      "name": "Nimer Adeeb"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA"
      ],
      "name": "Muhammed Amir Essibayi"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA"
      ],
      "name": "Motaz Daraghma"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA"
      ],
      "name": "Kareem El Naamani"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA"
      ],
      "name": "Nils Henninger"
    },
    {
      "affiliations": [
        "Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA"
      ],
      "name": "Sri Hari Sundararajan"
    },
    {
      "affiliations": [
        "Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA"
      ],
      "name": "Anna Luisa Kuhn"
    },
    {
      "affiliations": [
        "Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA"
      ],
      "name": "Jane Khalife"
    },
    {
      "affiliations": [
        "Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA"
      ],
      "name": "Sherief Ghozy"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Henri Mondor Hospital, Creteil, France"
      ],
      "name": "Luca Scarcia"
    },
    {
      "affiliations": [
        "Department of Medicine,Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Leonard LL Yeo"
    },
    {
      "affiliations": [
        "Department of Medicine,Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Division of Neurology, Department of Medicine, National University Hospital, Singapore"
      ],
      "name": "Benjamin YQ Tan"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada"
      ],
      "name": "Robert W Regenhardt"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA"
      ],
      "name": "Jeremy Josef Heit"
    },
    {
      "affiliations": [
        "Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy"
      ],
      "name": "Nicole M Cancelliere"
    },
    {
      "affiliations": [
        "University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, France"
      ],
      "name": "Aymeric Rouchaud"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "Jens Fiehler"
    },
    {
      "affiliations": [
        "Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA"
      ],
      "name": "Sunil A Sheth"
    },
    {
      "affiliations": [
        "Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA"
      ],
      "name": "Ajit S Puri"
    },
    {
      "affiliations": [
        "Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany"
      ],
      "name": "Christian Dyzmann"
    },
    {
      "affiliations": [
        "Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA"
      ],
      "name": "Marco Colasurdo"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France"
      ],
      "name": "Leonardo Renieri"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal"
      ],
      "name": "João Pedro Filipe"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH"
      ],
      "name": "Pablo Harker"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France"
      ],
      "name": "Răzvan Alexandru Radu"
    },
    {
      "affiliations": [
        "Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA"
      ],
      "name": "Mohamad Abdalkader"
    },
    {
      "affiliations": [
        "Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA"
      ],
      "name": "Piers Klein"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada"
      ],
      "name": "Thomas R Marotta"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada"
      ],
      "name": "Julian Spears"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan"
      ],
      "name": "Takahiro Ota"
    },
    {
      "affiliations": [
        "Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), 1200 North State St, Suite 3300, Los Angeles, CA"
      ],
      "name": "Ashkan Mowla"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA"
      ],
      "name": "Pascal Jabbour"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, Westchester"
      ],
      "name": "Arundhati Biswas"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium"
      ],
      "name": "Frédéric Clarençon"
    },
    {
      "affiliations": [
        "Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA"
      ],
      "name": "James E Siegler"
    },
    {
      "affiliations": [
        "Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA"
      ],
      "name": "Thanh N Nguyen"
    },
    {
      "affiliations": [
        "Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal"
      ],
      "name": "Ricardo Varela"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA"
      ],
      "name": "Amanda Baker"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA"
      ],
      "name": "David Altschul"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA"
      ],
      "name": "Nestor Gonzalez"
    },
    {
      "affiliations": [
        "Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany"
      ],
      "name": "Markus A Möhlenbruch"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France"
      ],
      "name": "Vincent Costalat"
    },
    {
      "affiliations": [
        "INSERM U1254, IADI, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France",
        "Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France"
      ],
      "name": "Benjamin Gory"
    },
    {
      "affiliations": [
        "Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany"
      ],
      "name": "Christian Paul Stracke"
    },
    {
      "affiliations": [
        "Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria"
      ],
      "name": "Constantin Hecker"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France"
      ],
      "name": "Gaultier Marnat"
    },
    {
      "affiliations": [
        "Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA"
      ],
      "name": "Hamza Shaikh"
    },
    {
      "affiliations": [
        "Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria"
      ],
      "name": "Christoph J Griessenauer"
    },
    {
      "affiliations": [
        "UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA"
      ],
      "name": "David S Liebeskind"
    },
    {
      "affiliations": [
        "UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Metropolitan, Italy"
      ],
      "name": "Alessandro Pedicelli"
    },
    {
      "affiliations": [
        "UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Metropolitan, Italy"
      ],
      "name": "Andrea Maria Alexandre"
    },
    {
      "affiliations": [
        "Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium"
      ],
      "name": "Illario Tancredi"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Henri Mondor Hospital, Creteil, France"
      ],
      "name": "Erwah Kalsoum"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA"
      ],
      "name": "Max Wintermark"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium"
      ],
      "name": "Boris Lubicz"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA"
      ],
      "name": "Aman B Patel"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada"
      ],
      "name": "Vitor Mendes Pereira"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA",
        "Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada",
        "Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium"
      ],
      "name": "Adrien Guenego"
    },
    {
      "affiliations": [],
      "name": "The MAD-MT Investigators"
    }
  ],
  "title": "Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory",
  "uid": "75e840f6-e566-5f80-9b56-4bdc21f76f9e"
}