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O-063 Endovascular therapy vs best medical management in distal medium middle cerebral artery acute ischemic stroke: a multinational multicenter propensity score-matched study
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  1. B Musmar1,
  2. N Adeeb2,
  3. AA Dmytriw3,
  4. A Guenego4,
  5. H Salim5,
  6. SI Tjoumakaris1,
  7. V Yedavalli5,
  8. P Jabbour1
  1. 1Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
  2. 2Neurological Surgery, Louisiana State University, Shreveport, LA
  3. 3Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  4. 4Neurological Surgery, Erasme University Hospital, Brussels, Belgium
  5. 5Radiology, Johns Hopkins University Hospital, Baltimore, MD

Abstract

Background The efficacy of endovascular treatment (EVT) in acute ischemic stroke due to distal medium vessel occlusion (DMVO) remains uncertain. Our study aimed to evaluate the safety and efficacy of EVT compared to best medical management (BMM) in DMVO.

Methods In this prospectively collected, retrospectively reviewed, multicenter cohort study, we analyzed data from MAD-MT registry. Patients with acute ischemic stroke due to DMVO in the M2, M3, and M4 segments who underwent EVT or received BMM were included. The primary outcomes were functional independence (modified Rankin Scale [mRS] score of 0–2) at 90 days, with secondary outcomes including excellent outcome (mRS 0–1), mortality (mRS 6), and safety outcomes focused on hemorrhagic complications. Propensity score matching was employed to balance the cohorts.

Results A total of 1,779 patients were analyzed before propensity score matching (374 in the BMM group and 1,405 in the EVT group). After matching, 694 patients were included (347 in each group). The EVT group did not demonstrate significant improvement in functional independence at 90 days compared to the BMM group (adjusted OR 0.94, 95% CI 0.61–1.45; p=0.78). However, the EVT group exhibited increased 90-day mortality (adjusted OR 1.73, 95% CI 1.02–2.96; p=0.044) and higher rates of symptomatic intracerebral hemorrhage and other hemorrhagic complications.

Conclusion Our findings suggest that while EVT does not significantly improve functional outcomes compared to BMM in DMVO, it is associated with higher risks of mortality and hemorrhagic complications. These results support a cautious approach to the use of EVT in DMVO and highlight the need for further prospective randomized trials to refine treatment strategies.

Disclosures B. Musmar: None. N. Adeeb: None. A. A Dmytriw: None. A. Guenego: None. H. Salim: None. S. I Tjoumakaris: None. V. Yedavalli: None. P. Jabbour: None.

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