{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T03:42:18Z","timestamp":1788406938394,"version":"build-2803163510"},"reference-count":38,"publisher":"Korean Stroke Society","issue":"3","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["j-stroke.org"],"crossmark-restriction":true},"short-container-title":["J Stroke"],"published-print":{"date-parts":[[2024,9,30]]},"abstract":"<jats:p>Background and Purpose The management of acute ischemic stroke (AIS) due to distal medium vessel occlusion (DMVO) remains uncertain, particularly in comparing the effectiveness of intravenous thrombolysis (IVT) plus mechanical thrombectomy (MT) versus IVT alone. This study aimed to evaluate the safety and efficacy in DMVO patients treated with either MT-IVT or IVT alone.Methods This multinational study analyzed data from 37 centers across North America, Asia, and Europe. Patients with AIS due to DMVO were included, with data collected from September 2017 to July 2023. The primary outcome was functional independence, with secondary outcomes including mortality and safety measures such as types of intracerebral hemorrhage.Results The study involved 1,057 patients before matching, and 640 patients post-matching. Functional outcomes at 90 days showed no significant difference between groups in achieving good functional recovery (modified Rankin Scale 0\u20131 and 0\u20132), with adjusted odds ratios (OR) of 1.21 (95% confidence interval [CI] 0.81 to 1.79; &lt;i&gt;P&lt;\/i&gt;=0.35) and 1.00 (95% CI 0.66 to 1.51; &lt;i&gt;P&lt;\/i&gt;&gt;0.99), respectively. Mortality rates at 90 days were similar between the two groups (OR 0.75, 95% CI 0.44 to 1.29; &lt;i&gt;P&lt;\/i&gt;=0.30). The incidence of symptomatic intracerebral hemorrhage was comparable, but any type of intracranial hemorrhage was significantly higher in the MT-IVT group (OR 0.43, 95% CI 0.29 to 0.63; &lt;i&gt;P&lt;\/i&gt;&lt;0.001).Conclusion The results of this study indicate that while MT-IVT and IVT alone show similar functional and mortality outcomes in DMVO patients, MT-IVT presents a higher risk of hemorrhagic complications, thus MT-IVT may not routinely offer additional benefits over IVT alone for all DMVO stroke patients. Further prospective randomized trials are needed to identify patient subgroups most likely to benefit from MT-IVT treatment in DMVO.<\/jats:p>","DOI":"10.5853\/jos.2024.01389","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:27:24Z","timestamp":1726187244000},"page":"434-445","update-policy":"https:\/\/doi.org\/10.5853\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study"],"prefix":"10.5853","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5208-8425","authenticated-orcid":true,"given":"Hamza Adel","family":"Salim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Yedavalli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basel","family":"Musmar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimer","family":"Adeeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed Amir","family":"Essibayi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kareem El","family":"Naamani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Henninger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri Hari","family":"Sundararajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Luisa","family":"K\u00fchn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Khalife","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherief","family":"Ghozy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Scarcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin Y.Q.","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Pulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy J.","family":"Heit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Regenhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M.","family":"Cancelliere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D.","family":"Bernstock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aymeric","family":"Rouchaud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Fiehler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Sheth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit S.","family":"Puri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Dyzmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Colasurdo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Barreau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Renieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Pedro","family":"Filipe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Harker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razvan Alexandru","family":"Radu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R.","family":"Marotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Spears","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Ota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashkan","family":"Mowla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arundhati","family":"Biswas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Claren\u00e7on","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Siegler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Varela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Altschul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nestor R.","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus A.","family":"M\u00f6hlenbruch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Costalat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Gory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Paul","family":"Stracke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Ali","family":"Aziz-Sultan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin","family":"Hecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Shaikh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Liebeskind","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Pedicelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea M.","family":"Alexandre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Illario","family":"Tancredi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias D.","family":"Faizy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwah","family":"Kalsoum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Lubicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman B.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vitor Mendes","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Guenego","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-5699","authenticated-orcid":true,"given":"Adam A.","family":"Dmytriw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the MAD MT Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3882","reference":[{"key":"ref1","first-page":"11","volume-title":"A randomized trial of intraarterial treatment for acute ischemic stroke","author":"Berkhemer","year":"2015"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1503780"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1415061"},{"key":"ref4","first-page":"1019","volume-title":"Randomized assessment of rapid endovascular treatment of ischemic stroke","author":"Goyal","year":"2015"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)00163-x"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2021-017321"},{"key":"ref7","volume-title":"Trial review: trial registered on ANZCTR [Internet]","year":"2021"},{"key":"ref8","first-page":"328","volume-title":"Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: a retrospective, multicenter, and multinational study","author":"Dmytriw","year":"2024"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.120.028956"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.2773"},{"key":"ref11","first-page":"e233041","volume-title":"Assessment of thrombectomy versus combined thrombolysis and thrombectomy in patients with acute ischemic stroke and medium vessel occlusion","author":"Dmytriw","year":"2024"},{"key":"ref12","first-page":"e000931","volume-title":"Aspiration versus stent-retriever as first-line endovascular therapy technique for primary medium and distal intracranial occlusions: a propensity-score matched multicenter analysis","author":"Siegler","year":"2023"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1177\/23969873241249295"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s00062-024-01415-1"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.4103\/sja.sja_543_18"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040296"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.115.010049"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1214\/09-sts313"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/70.1.41"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.113.002751"},{"key":"ref21","first-page":"1080","volume-title":"Safety of thrombolysis in stroke mimics: results from a multicenter cohort study","author":"Zinkstok","year":"2013"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0b013e31822c9135"},{"key":"ref23","first-page":"29","volume-title":"","author":"Rubin","year":"2018"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2020-015807"},{"key":"ref25","first-page":"e344","volume-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","author":"Powers","year":"2019"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2018-014569"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2022-019717"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.38154"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.118.020567"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-023-07089-w"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.119.026907"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2017-013515"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1159\/000445809"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.118.022114"},{"key":"ref35","first-page":"e2839","volume-title":"Clinical and neuroimaging outcomes of direct thrombectomy vs bridging therapy in large vessel occlusion: analysis of the SELECT cohort study","author":"Sarraj","year":"2021"},{"key":"ref36","first-page":"e1436","volume-title":"IV thrombolysis initiated before transfer for endovascular stroke thrombectomy: a systematic review and meta-analysis","author":"Katsanos","year":"2023"},{"key":"ref37","first-page":"156","volume-title":"Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial","author":"Khatri","year":"2018"},{"key":"ref38","first-page":"2135","volume-title":"Dual antiplatelet therapy vs alteplase for patients with minor nondisabling acute ischemic stroke: the ARAMIS randomized clinical trial","author":"Chen","year":"2023"}],"container-title":["Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/j-stroke.org\/upload\/pdf\/jos-2024-01389.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/j-stroke.org\/journal\/view.php?doi=10.5853\/jos.2024.01389","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/j-stroke.org\/upload\/pdf\/jos-2024-01389.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T11:14:32Z","timestamp":1728558872000},"score":1,"resource":{"primary":{"URL":"http:\/\/j-stroke.org\/journal\/view.php?doi=10.5853\/jos.2024.01389"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,30]]},"references-count":38,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,9]]}},"URL":"https:\/\/doi.org\/10.5853\/jos.2024.01389","relation":{},"ISSN":["2287-6391","2287-6405"],"issn-type":[{"value":"2287-6391","type":"print"},{"value":"2287-6405","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,30]]},"assertion":[{"value":"2024-04-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-13","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}