Published

Neurosciences

Mechanical Thrombectomy in Ischemic Stroke With a Medium or Distal Arterial Occlusion

Published on - JAMA Cardiology

Authors: Frédéric Clarençon, Fouzi Bala, Amandine Baptiste, Marco Pasi, Gaultier Marnat, Igor Sibon, Benjamin Gory, Sébastien Richard, Raoul Pop, Valérie Wolff, Cédric Fauché, Matthias Lamy, Vincent Costalat, Caroline Arquizan, Christine Rodriguez-Régent, Guillaume Turc, Christophe Cognard, Louis Fontaine, Federico Di Maria, Bertrand Lapergue, Nicolas Bricout, Hilde Henon, Titien Tuilier, Aymeric Wittwer, Pierre Louis Alexandre, Solène de Gaalon, Laurent Spelle, Christian Denier, Emmanuel Chabert, Anna Ferrier, Aymeric Rouchaud, Francisco Macian-Montoro, Sébastien Soize, Solène Moulin, William Boisseau, Candice Sabben, Charlotte Barbier, Marion Boulanger, Omer Faruk Eker, Tae-Hee Cho, Jean-Christophe Gentric, Serge Timsit, Marc-Antoine Labeyrie, Peggy Reiner, Fernando Pico, Isabelle Durand-Zaleski, Sonia Alamowitch, Agnès Dechartres, Rémy Beaujeux, Dan Mihoc, Monica Manisor, Véronique Quenardelle, Irène Pierre-Paul, Roxana Gheoca, Emmanuel Wiener, Ian Leonard-Lorant, Anca Hasiu, René Anxionnat, Anne-Laure Derelle, Liang Liao, François Zhu, Oana Harsan, Emmanuelle Schmitt, Sophie Planel, Lisa Humbertjean-Selton, Gioia Mione, Jean-Christophe Lacour, Marian Douarinou, Nabil Kassem, Emilien Micard, Bailiang Chen, Marcela Voicu, Marie Reitter, Madalina Brezeanu, Adriana Tabarna, Iona Podar, Pauline Bourst, Grégoire Barthel, Alexandre Voulot, Guillaume Thebault, Catherine Morais, Adrien Wang, Oguzhan Coskun, Silvia Pizzuto, Alessandro Sgreccia, David Weisenburger-Lile, Maia Tchikviladze, Constance Lesoil-Markowski, Victoria Vernier, Cédric Batot, Manon Escalere, Georges Rodesch, Arturo Consoli, Delphine Lopez, Lisa Neumann, Vittorio Civelli, Alexis Guédon, Agnès Aghetti, Stéphanie Guey, Tuan Huy Tran, Mikael Mazighi, Giulia Frasca-Polara, Hugues Chabriat, Eric Jouvent, Mathilde Aubertin, Emmanuel Houdart, Jean-Pierre Saint-Maurice, Francesco Arpaia, Matteo Fantoni, Olivier Naggara, Valérie Domigo, Wagih Ben Hassen, Clémence Liégeois, Antoine Dusonchet, Denis Trystram, Clothilde Isabel, Hugo Gortais, Nicolas Mélé, Catherine Oppenheim, David Calvet, Despina Messimeris, Armand Aymard, François Lun, Charbel Mounayer, Suzana Saleme, Simon Frachet, Alexandre Cosnard, Charlotte Rosso, Sara Leder, Flore Baronnet, Sophie Crozier Mortreux, Anne Léger, Laure Bottin, Sam Ghazanfari, Marion Yger, Stephen Delorme, Christine Vassilev, Clémence Blanc, Nader Sourour, Eimad Shotar, Stéphanie Lenck, Kévin Premat, Julien Allard, Louisette Padra, Pierre-Marie Chiaroni, Antonio Rainone, Gaspard Gerschenfeld, Julien Ognard, François-Mathias Merrien, Denis Maréchal, Marie Bruguet, Philippe Goas, Sandrine Normant, Géraldine Viard, Mourad Cheddad El Aouni, Sophie Le Hir, Audrey Campos, Irina Viakhireva-Dovganuk, Christophe Rivière-Paya, Xavier Barreau, Jérôme Berge, Jean-Sébastien Liegey, Pierre Briau, Lisa Papillon, Jean Papaxanthos, Sabrina Debruxelles, Stéphane Olindo, Mathilde Poli, Pauline Renou, Victoire Lyon, Aurélie Boyer, Sharmila Sagnier, Thomas Tourdias, Thomas Courret, Malgorzata Milnerowicz, Tristan Kerdraon, Lisa Saleille, Camille Dallies-Labourdette, Léa Donnadieu, Sylvain Ledure, Anne-Christine Januel, Fabrice Bonneville, Guillaume Bellanger, Philippe Tall, Federico Sacchetti, Jean-Marc Olivot, Lionel Calviere, Alain Viguier, Jean-François Albucher, Charlotte Periole, Nicolas Raposo, Gabrielle Sill, Hélène Catala, Laurent Derex, Julia Fontaine, Laura Mechtouff, Norbert Nighoghossian, Elodie Ong, Lucie Rascle, Roberto Riva, Francis Turjman, Morgane Laubacher, Mehdi Beyragued, Yves Berthezene, Marc Hermier, Ameli Roxanna, Alexandre Bani-Sadr, Andrea Filip, Matteo Cappucci, Adeline Mansuy, Apolline Barbe, Morgane Bouin, Ricardo Moreno-Gomez, Daniel Pontal, Quentin Fleury, Romain Bourcier, Hubert Desal, Benjamin Daumas-Duport, Guillaume Tessier, Arthur Lionnet, Benoît Guillon, Simon Lassoze, Pacôme Constant Dit Beaufils, Cédric Lenoble, Cécile Preterre, Cyril Dargazanli, Isabelle Mourand, Lucas Corti, Adrien ter Schiphorst, Federico Cagnazzo, Imad Derraz, Mehdi Mahmoudi, Pierre-Henri Lefevre, Grégory Gascou, François-Louis Collemiche, Quentin Varnier, Sophie Huby, Mahmoud Charif, Pauline Prin, Thibaut Roux, Arthur Attal, Justine Petitfour, Cédric Turpinat, Thomas Checkouri, Jonathan Cortese, Jildaz Caroff, Vanessa Chalumeau, Cristian Mihalea, Nicolas Legris, Augustin Ozanne, Leon Ikka, Olivier Chassin, Sophie Gallas, Laura Venditti, Mariana Sarov-Rivière, Mihaela Husleag, Julien Ducasse, Mathieu Vieira, Julien Cogez, Sophie Guettier, Estelle La Porte, Jean Bouchart, Damien Chevanne, Maxime Gauberti, Grégoire Braux, Mohammad Ismail, Mohamad Fadi Salkine, Romain Schneckenburger, Laurent Pierot, Vi Tuan Hua, Paolo Pagano, Alexandre Doucet, Christophe Gelmini, Pierre-François Manceau, Laurentiu Paiusan, Isabelle Serre, Thi Ngoc Phuong Nguyen, Maher Sahnoun, Nathalie Caucheteux, Gwendoline Arnoult, Siwar Ayari, Christophe Portefaix, Margaux Bonnaire, Abderrahim Zerroug, Ricardo Moreno, Elie Lteif, Pauline Paris, Nathalie Bourgois, Marie Raquin, Géraud Forestier, Ludovic Blanchard, Stéphane Velasco, Samy Boucebci, Nicolas Raynaud, Victor Dumas, Jean-Philippe Neau, Céline Thomarat, Mélodie Pillet, Séverine Laurin, Nathalie Nasr, Mathilde Dupin, Ayoub Guerrab, Héloïse Ifergan, Grégoire Boulouis, Richard Bibi, Denis Herbreteau, Clémence Hoche, Arnaud Bretonnière, Marie Gaudron, Élisabeth Molinier, Kevin Janot, Vladimir Charron, Abderrahim El Houfia, Elodie Barritaud, Nicolas Charron, Mariam Annan, Séverine Debiais, Thomas Personnic, Martin Bretzner, Nelly Dequatre, Marie Bodenant, Laurent Puy, François Caparros, Lucie Dellaschiava, Kaelig Watel, Thomas Accettone, Adrien Marchal, Firas Farhat, Anceline Dong, Frédéric Faugeras, Luca Scarcia, Erwah Kalsoum, Jean-Philippe Desilles, Raphaël Blanc, Michel Piotin, Simon Escalard, Humain Baharvahdath, Hocine Redjem, Amira Al Raaisi, Stanislas Smajda, Erwan Robichon, Arthur Gutter, Benjamin Maïer, Grace Adwane, Aurelien Freiherr von Seckendorff, Cristina Hobeanu, Ada Boutelier, Pierre Seners, Christelle Nilles, Igor Raynouard, Nefeli Valyraki, Charon Christophe

See the publication on HAL DOI

Importance Evidence regarding efficacy and safety of thrombectomy in acute ischemic stroke (AIS) due to medium or distal vessel occlusions (MDVOs) is lacking. Objective To evaluate the benefit of thrombectomy, in addition to medical treatment over medical treatment alone, in patients with an AIS related to a primary and isolated MDVO. Design, Setting, and Participants Randomized clinical trial conducted at 22 stroke centers in France from November 2021 to April 2025, with planned enrollment of 488 patients. The trial has been stopped after the planned interim analysis on the recommendation of the data and safety monitoring board for futility and increased rate of symptomatic intracranial hemorrhage with thrombectomy. Eligible adult patients had an AIS due to a primary MDVO within 8 hours of symptom onset or within 24 hours of last seen well if no hyperintense signal was present on fluid-attenuated inversion recovery imaging. Intervention Thrombectomy in addition to medical treatment (n = 123) or medical treatment alone (n = 121). Main Outcomes and Measures The primary end point was a good clinical outcome at 3 months, defined as a modified Rankin Scale score of 0 to 2, assessed by an independent, blinded assessor. Secondary end points included mortality rate at 3 months and adverse and serious adverse events. Results Of the 244 patients randomized (median age, 75 years [IQR, 67-81]; 56% male; median National Institutes of Health Stroke Scale score, 8 [IQR, 6-12]), 100 of the 123 patients in the thrombectomy group (81%) received thrombectomy and none of the 121 patients in the control group received thrombectomy; 217 (89%) completed follow-up. At 3 months, 72 of 116 patients (62%) in the thrombectomy group had a good clinical outcome vs 81 of 119 patients (68%) in the control group (odds ratio, 0.73 [95% CI, 0.40-1.31]; P = .29; adjusted absolute difference, −6.8% [95% CI, −19.4% to 5.7%]). The incidence of symptomatic intracranial hemorrhages was higher among the 100 patients who actually received thrombectomy than in those who did not (11% vs 3%, P = .008), as was incidence of subarachnoid hemorrhages (13% vs 2%, P < .001) and embolus migration (5% vs 1%, P = .04). Mortality rate did not significantly differ between the 2 groups (6% vs 8%; P = .49). Conclusions and Relevance Thrombectomy did not lead to a higher rate of good clinical outcome at 3 months compared with medical treatment alone in patients with acute ischemic stroke related to an MDVO. Hemorrhagic complications were more frequent after thrombectomy. Trial Registration ClinicalTrials.gov Identifier: NCT05030142