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Endovascular Thrombectomy versus Medical Management in Isolated M2 Occlusions: Pooled Patient-Level Analysis from the EXTEND-IA Trials, INSPIRE and SELECT Studies. Annals of neurology Sarraj, A., Parsons, M., Bivard, A., Hassan, A. E., Abraham, M. G., Wu, T., Kleinig, T., Lin, L., Chen, C. A., Levi, C., Dong, Q., Cheng, X., Butcher, K. S., Choi, P., Yassi, N., Shah, D., Sharma, G., Pujara, D., Shaker, F., Blackburn, S., Dewey, H., Thijs, V., Sitton, C. W., Donnan, G. A., Mitchell, P. J., Yan, B., Grotta, J. G., Albers, G. W., Davis, S. M., Campbell, B., SELECT Investigators, t. E. 2022

Abstract

OBJECTIVE: To evaluate functional and safety outcomes of Endovascular thrombectomy(EVT) vs Medical Management(MM) in patients with M2 occlusion and examine their association with perfusion imaging mismatch and stroke severity.METHODS: In a pooled, patient-level analysis of 3 randomized controlled trials(EXTEND-IA, EXTEND-IA-TNK part 1&2) and 2 prospective non-randomized studies(INSPIRE&SELECT), we evaluated EVT association with 90-day functional independence(mRS 0-2) in isolated M2 occlusions as compared to medical management overall and in subgroups by mismatch profile status and stroke severity.RESULTS: We included 517 patients(EVT=195, MM=322), baseline median(IQR) NIHSS was 13(8-19) in EVT vs 10(6-15) in MM, p<0.001. Pre-treatment ischemic core did not differ(EVT=10(0-24)mL vs MM=9(3-21)mL, p=0.59). Compared to MM, EVT was more frequently associated with functional independence(68.3% vs 61.6%, aOR=2.42,95%CI=1.25-4.67, p=0.008,IPTW-OR=1.75,95% CI=1.00-3.75,p=0.05) with a shift towards better mRS outcomes(adjusted cOR=2.02,95%CI:1.23-3.29,p=0.005), and lower mortality(5% vs 10%, aOR=0.32,95%CI=0.12-0.87,p=0.025). EVT was associated with higher functional independence in patients with a perfusion mismatch profile(EVT=70.7% vs MM=61.3%, aOR=2.29, 95%CI=1.09-4.79,p=0.029, IPTW-OR=2.02,1.08-3.78,p=0.029), whereas no difference was found in those without mismatch(EVT=43.8% vs MM=62.7%,p=0.17, IPTW-OR: 0.71,95% CI=0.18-2.78,p=0.62). Functional independence was more frequent with EVT in patients with moderate or severe strokes, as defined by baseline NIHSS above any thresholds from 6-10, whereas there was no difference between groups with milder strokes below these thresholds.INTERPRETATION: In patients with M2 occlusion, EVT was associated with improved clinical outcomes when compared to medical management. This association was primarily observed in patients with a mismatch profile and those with higher stroke severity. This article is protected by copyright. All rights reserved.

View details for DOI 10.1002/ana.26331

View details for PubMedID 35184327