| Title: |
Endovascular Therapy for Late-Window M2-Segment Middle Cerebral Artery Occlusion: Analysis of the CLEAR Study. |
| Authors: |
Winzer, S.; Kaiser, D. P. O.; Qureshi, M. M.; Castonguay, A. C.; Strbian, D.; Nogueira, R. G.; Nagel, S.; Raymond, J.; Abdalkader, M.; Demeestere, J.; Marto, J. P.; Yamagami, H.; Tanaka, K.; Sheth, S. A.; Dusart, A.; Michel, P.; Olive Gadea, M.; Ribo, M.; Zaidat, O. O.; Haussen, D. C.; Henon, Hilde; Mohammaden, M. H.; Möhlenbruch, M. A.; Siegler, J. E.; Puri, A. S.; Kaesmacher, J.; Klein, P.; Tomppo, L.; Caparros, François; Ramos, J. N.; Jumaa, M.; Zaidi, S.; Martinez-Majander, N.; Nannoni, S.; Vandewalle, L.; Bellante, F.; Galecio-Castillo, M.; Salazar-Marioni, S.; Virtanen, P.; Wouters, A.; Ventura, R.; Jesser, J.; Mujanovic, A.; Shu, L.; Qureshi, A.; Qiu, Z.; Masoud, H. E.; Requena, M.; Sillanpää, M.; Hu, W.; Lin, E.; Cordonnier, Charlotte; Roy, D.; Yaghi, S.; Strambo, D.; Fischer, U.; Ortega-Gutierrez, S.; Lemmens, R.; Ringleb, P. A.; Nguyen, T. N.; Puetz, V. |
| Contributors: |
Technische Universität Dresden = Dresden University of Technology (TU Dresden); Boston University School of Medicine (BUSM); Boston University Boston (BU); University of Toledo; Helsingin yliopisto = Helsingfors universitet = University of Helsinki; University of Pittsburgh Medical Center Pittsburgh, PA, États-Unis (UPMC); Heidelberg University Hospital Heidelberg; Centre Hospitalier de l'Université de Montréal (CHUM); Université de Montréal (UdeM); Tufts Medical Center Boston; Universitair Ziekenhuis Leuven = University Hospital of Leuven = Hopital universitaire de Louvain (UZ Leuven); Hospital De Egas Moniz Lisbon; Centro Hospitalar Universitário Lisboa Central; Université de Tsukuba = University of Tsukuba; Kindai University; Centre Marie Curie; Service of Neurology CHUV, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital Lausanne (CHUV); Vall d'Hebron University Hospital Barcelona; Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc); Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille; University of Chicago; University of Massachusetts Medical School Worcester (UMASS); University of Massachusetts System (UMASS); Universität Bern = University of Bern = Université de Berne (UNIBE); Helsinki University Hospital Finland (HUS); Lille Neurosciences & Cognition - U 1172 (LilNCog); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); University of Cambridge Cambridge, UK (CAM); Universiteit Gent = Ghent University = Université de Gand (UGent); University of Iowa Iowa City; Bern University Hospital Berne (Inselspital); Rhode Island Hospital Providence, RI, États-Unis; Zhejiang University Hangzhou, China; SUNY Upstate Medical University; State University of New York (SUNY); University of Science and Technology of China Hefei (USTC); Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM); Université de Montréal (UdeM)-Université de Montréal (UdeM); Université de Lausanne = University of Lausanne (UNIL); University Hospital Carl Gustav Carus Dresden, Germany |
| Source: |
ISSN: 0039-2499. |
| Publisher Information: |
CCSD; American Heart Association |
| Publication Year: |
2025 |
| Collection: |
LillOA (HAL Lille Open Archive, Université de Lille) |
| Subject Terms: |
middle cerebral artery; ischemic stroke; intracranial hemorrhage; endovascular procedures; cohort studies; [SDV]Life Sciences [q-bio] |
| Description: |
International audience ; Background: There is uncertainty about whether patients with M2 occlusion benefit from endovascular therapy (EVT) in the late (6-24-hour) time window. We evaluated the clinical outcomes of patients with M2 occlusion selected for EVT compared with those who received medical management (MM) in the late window.Methods: This multinational cohort study was conducted at 66 sites across 10 countries (January 2014 to May 2022). We included consecutive patients with late-window stroke due to M2 occlusion, baseline National Institutes of Health Stroke Scale score of ≥5, and premorbid modified Rankin Scale score of ≤2 who received EVT or MM alone. The primary end point was 90-day ordinal shift in the modified Rankin Scale score. Safety end points were symptomatic intracranial hemorrhage and 90-day mortality. Differences in outcomes were determined using inverse probability of treatment weighting-adjusted logistic regression models.Results: Among 5098 patients, 496 met inclusion criteria (median [interquartile range] age, 74 years [62-81 years]; baseline National Institutes of Health Stroke Scale score, 12 [8-17]), of whom 394 (79.4%) received EVT and 102 (20.6%) MM. In inverse probability of treatment weighting adjusted analyses, there was no favorable 90-day ordinal modified Rankin Scale shift (odds ratio, 1.39 [95% CI, 0.92-2.12]) and no difference of functional independence rates (modified Rankin Scale score of 0-2; odds ratio, 1.72 [95% CI, 0.93-3.15]) with EVT compared with MM. Moreover, symptomatic intracranial hemorrhage risk (odds ratio, 3.46 [95% CI, 0.50-23.92]) and 90-day mortality (odds ratio, 1.11 [95% CI, 0.66-1.87]) were not statistically different between treatment groups.Conclusions: In patients with M2 occlusion in the 6- to 24-hour time window, there was no difference in disability outcomes or symptomatic intracranial hemorrhage risk between patients treated with EVT compared with MM. Results of ongoing randomized trials will provide further insight. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/40405459; PUBMED: 40405459 |
| DOI: |
10.1161/STROKEAHA.124.048840 |
| Availability: |
https://lilloa.hal.science/hal-05291285; https://doi.org/10.1161/STROKEAHA.124.048840 |
| Accession Number: |
edsbas.90F78E98 |
| Database: |
BASE |