{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T03:57:43Z","timestamp":1784779063491,"version":"3.55.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The benefits of endovascular thrombectomy (EVT) for distal medium vessel occlusions (DMVOs) are not well established. This study aimed to determine the superiority of EVT over intravenous tissue\u2010type plasminogen activator (IV tPA) in the treatment of DMVOs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">This study analyzed data from the Kanagawa Intravenous and Endovascular Treatment of Acute Ischemic Stroke Registry, a prospective, multicenter, observational registry of acute ischemic stroke patients treated with EVT or IV tPA. The study evaluated patients with acute DMVOs who were treated with EVT and\/or IV tPA. DMVOs was defined as occlusions in M2\u2013M3 segment of the middle cerebral artery, anterior cerebral artery, or posterior cerebral artery. The analysis included primary DMVOs and excluded secondary DMVOs, such as distal embolism after recanalization of proximal vessel occlusion. Propensity score\u2010matched analysis was conducted to compare the outcomes between EVT and IV tPA alone. A good outcome was defined as a modified Rankin Scale score 0\u20132 or no worsening at 90 days. An excellent outcome was defined as an modified Rankin Scale score 0\u20131.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The study included 1148 patients with DMVOs, of whom 816 were treated with EVT and 332 were IV tPA alone. Before propensity score matching, the incidence of good and excellent outcomes was significantly lower in EVT group (good outcomes: EVT 50.3% versus IV tPA 68.0%;\n              <jats:italic>P<\/jats:italic>\n              \u00a0&lt;\u00a00.01; excellent outcomes: 39.8% versus 59.8%;\n              <jats:italic>P<\/jats:italic>\n              \u00a0&lt;\u00a00.001). After propensity score matching, there were no significant differences between EVT and IV tPA groups in good outcomes (EVT 57.8% versus IV tPA 61.3%;\n              <jats:italic>P<\/jats:italic>\n              \u00a0=\u00a00.51), excellent outcomes (46.6% versus 55.0%;\n              <jats:italic>P<\/jats:italic>\n              \u00a0=\u00a00.17), all cerebral hemorrhage (11.6% versus 12.7%;\n              <jats:italic>P<\/jats:italic>\n              \u00a0=\u00a00.74), and symptomatic hemorrhage (2.9% versus 0.6%;\n              <jats:italic>P<\/jats:italic>\n              \u00a0=\u00a00.13). Subarachnoid hemorrhage was more frequent in EVT group (14.5% versus IV tPA 0%).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p xml:lang=\"en\">The benefits of EVT for acute DMVOs were similar to IV tPA alone. Randomized multicenter trials are warranted to establish the superiority of EVT over IV tPA alone for DMVOs.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/svin.123.001346","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T06:48:47Z","timestamp":1720421327000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Endovascular Thrombectomy Versus Intravenous Alteplase For Distal Medium Vessel Occlusions: A Propensity Score\u2010Matched Analysis"],"prefix":"10.1161","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9302-5511","authenticated-orcid":false,"given":"Tomohide","family":"Yoshie","sequence":"first","affiliation":[{"name":"Department of Neurology and Neuroendovascular Therapy Stroke Center St. Marianna University Toyoko Hospital Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiro","family":"Ueda","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neuroendovascular Therapy Stroke Center St. Marianna University Toyoko Hospital Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Neurology St. Marianna University School of Medicine Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masataka","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Seisho Hospital Odawara Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Morimoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Yokohama Shintoshi Neurosurgical Hospital Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshifumi","family":"Tsuboi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Kawasakisaiwai Hospital Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoo","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Neurology Yokohama Brain and Spine Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shogo","family":"Kaku","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Neurosurgical East Yokohama Hospital Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Ayabe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Yokosuka Kyosai Hospital Yokosuka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takekazu","family":"Akiyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Akiyama Neurosurgical Hospital Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Kitasato University Hospital Sagamihara Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Yokohama Sakae Kyosai Hospital Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kagami","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Saiseikai Yokohamashi Tobu Hospital Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidemichi","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery St. Mariannna University School of Medicine Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidetaka","family":"Onodera","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery St. Marianna University School of Medicine Yokohama City Seibu Hospital Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuyuki","family":"Kaga","sequence":"additional","affiliation":[{"name":"EPS corporation Tokyo Japan"},{"name":"Department of Practical Management of Medical Information St. Marianna University School of Medicine Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruki","family":"Ohtsubo","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neuroendovascular Therapy Stroke Center St. Marianna University Toyoko Hospital Kawasaki Japan"},{"name":"Department of Neurology Ehime Prefectural Central Hospital Matsuyama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Tatsuno","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neuroendovascular Therapy Stroke Center St. Marianna University Toyoko Hospital Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriko","family":"Usuki","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neuroendovascular Therapy Stroke Center St. Marianna University Toyoko Hospital Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Takaishi","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neuroendovascular Therapy Stroke Center St. Marianna University Toyoko Hospital Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihisa","family":"Yamano","sequence":"additional","affiliation":[{"name":"Department of Neurology St. Marianna University School of Medicine Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the K\u2010NET Registry Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00163-X"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1706442"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1713973"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.022606"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987319832140"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.014181"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.12498"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930221138014"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60149-4"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1177\/17474930221090347","article-title":"Japan stroke society guideline 2021 for the treatment of stroke","volume":"17","author":"Miyamoto S","year":"2022","unstructured":"Miyamoto S, Ogasawara K, Kuroda S, Itabashi R, Toyoda K, Itoh Y, Iguchi Y, Shiokawa Y, Takagi Y, Ohtsuki T, et\u00a0al. Japan stroke society guideline 2021 for the treatment of stroke. Int J Stroke. 2022;17:1039\u20101049. https:\/\/doi.org\/10.1177\/17474930221090347","journal-title":"Int J Stroke"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.022352"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.028956"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2022-019717"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2018-014678"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.2773"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.38154"},{"key":"e_1_3_2_18_2","doi-asserted-by":"crossref","DOI":"10.1148\/radiol.220229","article-title":"Thrombectomy versus medical management for isolated anterior cerebral artery stroke: an international multicenter registry study","volume":"307","author":"Meyer L","year":"2023","unstructured":"Meyer L, Stracke P, Broocks G, Elsharkawy M, Sporns P, Piechowiak EI, Kaesmacher J, Maegerlein C, Hernandez Petzsche MR, Zimmermann H, et\u00a0al. Thrombectomy versus medical management for isolated anterior cerebral artery stroke: an international multicenter registry study. Radiology. 2023;307:e220229. https:\/\/doi.org\/10.1148\/radiol.220229","journal-title":"Radiology"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2021.0001"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.042283"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.042674"}],"container-title":["Stroke: Vascular and Interventional Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/SVIN.123.001346","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T06:56:22Z","timestamp":1725346582000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/SVIN.123.001346"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1161\/SVIN.123.001346"],"URL":"https:\/\/doi.org\/10.1161\/svin.123.001346","relation":{},"ISSN":["2694-5746"],"issn-type":[{"value":"2694-5746","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]},"assertion":[{"value":"2024-01-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e001346"}}