Evidence map›Paper›PMID 39812774›Full record

ArticleNeuroradiology2025

Outcomes of mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke patients with ASPECTS 4-5 vs. 6-7: a retrospective, multicenter, and multinational study.

Basel Musmar, Hamza Adel Salim, Nimer Adeeb, Vivek Yedavalli, Dhairya Lakhani, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife and 53 more

Abstract readMulticenter Study
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In one paragraph

Article in Neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Observational
  2. Article
  3. Hypoperfusion intensity ratio is associated with follow-up infarct volume in medium vessel occlusions: A multicenter multinational study.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025
    Article
  4. Prolonged Venous Transit Is Associated With Unfavorable Outcomes in Anterior Circulation Distal Medium Vessel Stroke.Journal of neuroimaging : official journal of the American Society of Neuroimaging
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

63 authors.

Basel MusmarDepartment of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA.
Hamza Adel SalimDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA. Hamza.sleeem@gmail.com.ORCID http://orcid.org/0000-0002-5208-8425
Nimer AdeebDepartment of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA.
Vivek YedavalliDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Dhairya LakhaniDepartment of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.
Kareem El NaamaniDepartment of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
Nils HenningerDepartment of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Sri Hari SundararajanDepartment of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
Anna Luisa KühnDivision of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
Jane KhalifeCooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
Sherief GhozyDepartment of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
Luca ScarciaDepartment of Neuroradiology, Henri Mondor Hospital, Creteil, France.
Benjamin Y Q TanDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Robert W RegenhardtNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Jeremy J HeitDepartment of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
Nicole M CancelliereNeurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, Toronto Metropolitan University, Toronto, ON, Canada.
Joshua D BernstockDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Aymeric RouchaudUniversity Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
Jens FiehlerDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Sunil ShethDepartment of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
Ajit S PuriDivision of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
Christian DyzmannNeuroradiology Department, Sana KlinikenLübeck GmbH, Lübeck, Germany.
Marco ColasurdoDepartment of Interventional Radiology, Oregon Health and Science University, Portland, OR, 97239, USA.
Xavier BarreauInterventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
Leonardo RenieriInterventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy.
João Pedro FilipeDepartment of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário Do Porto, Porto, Portugal.
Pablo HarkerDepartment of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
Răzvan Alexandru RaduDepartment of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Mohamad AbdalkaderDepartment of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
Piers KleinDepartment of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
Thomas R MarottaNeurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, Toronto Metropolitan University, Toronto, ON, Canada.
Julian SpearsNeurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, Toronto Metropolitan University, Toronto, ON, Canada.
Takahiro OtaDepartment of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Ashkan MowlaDivision of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), 1200 North State St, Suite 3300, Los Angeles, CA, USA.
Pascal JabbourDepartment of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
Arundhati BiswasDepartment of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
Frédéric ClarençonDepartment of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
James E SieglerCooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
Thanh N NguyenDepartment of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
Ricardo VarelaDepartment of Neurology, Centro Hospitalar Universitário Do Porto, Porto, Portugal.
Amanda BakerDepartment of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Muhammed Amir EssibayiDepartment of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
David AltschulDepartment of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Nestor R GonzalezDepartment of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Markus A MöhlenbruchSektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
Vincent CostalatDepartment of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Benjamin GoryDepartment of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
Christian Paul StrackeDepartment of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany.
Mohammad Ali Aziz-SultanDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Constantin HeckerDepartment of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
Hamza ShaikhCooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
David S LiebeskindUCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA.
Alessandro PedicelliUOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Andrea M AlexandreUOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Illario TancrediDepartment of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
Tobias D FaizyDepartment of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany.
Erwah KalsoumDepartment of Neuroradiology, Henri Mondor Hospital, Creteil, France.
Boris LubiczDepartment of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Aman B PatelNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Vitor Mendes PereiraNeurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, Toronto Metropolitan University, Toronto, ON, Canada.
Adrien GuenegoDepartment of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Adam A DmytriwNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. admytriw@mgh.harvard.edu.
MAD MT Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionMechanical thrombectomy (MT) efficacy in medium vessel occlusion (MeVO) stroke, particularly in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), remains less explored.

methodsThis retrospective study analyzed data from 443 AIS patients treated with MT for MeVO and low ASPECTS (4-7) at 37 centers across North America, Asia, and Europe, from September 2017 to July 2021. Patients were categorized into ASPECTS of 4-5 and 6-7.

resultsOf 443 patients, 51 (12%) had ASPECTS of 4-5, and 392 (88%) had scores of 6-7. The median age was 65 years (IQR: 46-79), with a balanced sex distribution between the groups. The most common site of initial occlusion was M2 branch in both groups (92% in ASPECTS 4-5 and 85% in ASPECTS 6-7) (p = 0.68). The ASPECTS 4-5 group had lower TICI 2c-3 achievement (31% vs. 55%, p = 0.002) and poorer functional outcomes (mRS 0-1 at 90 days: 12% vs. 29%, p = 0.03) compared to the ASPECTS 6-7 group. Intracranial hemorrhagic complications were higher in the ASPECTS 4-5 group (69% vs. 47%, p = 0.007). Multivariable analysis revealed ASPECTS 6-7 to be associated with higher odds of TICI 2c-3 (OR: 2.5; CI: 1.28 to 4.89, p = 0.007) and lower odds of intracranial hemorrhagic complications (OR: 0.4; CI: 0.19 to 0.81, p = 0.012).

conclusionMT may be associated with improved outcomes in patients with moderate-to-low ASPECTS (6-7), though the lack of a control group limits definitive conclusions about its effectiveness. In patients with very low ASPECTS (4-5), higher rates of hemorrhagic complications and poorer outcomes were observed, but this does not necessarily preclude the use of MT. These findings highlight the need for further research and careful patient selection.

Indexed as

Ischemic StrokeThrombectomyAgedFemaleHumansMaleMiddle AgedRetrospective StudiesTomography, X-Ray ComputedTreatment OutcomeASPECTSMedium occlusionMulticenterStroke

Identifiers

PMID39812774

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