Evidence map›Paper›PMID 41291271›Full record

ArticleClinical neuroradiology2026

Intravenous Thrombolysis in Distal Medium Middle Cerebral Artery Occlusion Patients with Unsuccessful Mechanical Reperfusion.

Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Dhairya Lakhani, Orabi Hajjeh, Basel Musmar, Nimer Adeeb, Fathi Milhem, Davide Simonato, Yan-Lin Li and 57 more

Abstract readMulticenter Study
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Article in Clinical neuroradiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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67 authors.

Hamza Adel SalimDepartment of Neuroradiology, MD Anderson Medical Center, 77030, Houston, TX, USA. Hamza.sleeem@gmail.com.ORCID http://orcid.org/0000-0002-5208-8425
Benjamin PulliDepartment of Interventional Neuroradiology, Stanford Medical Center, Stanford Palo Alto, CA, USA.
Vivek YedavalliDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Dhairya LakhaniDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Orabi HajjehNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Basel MusmarDepartment of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
Nimer AdeebDepartment of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA, USA.
Fathi MilhemNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Davide SimonatoDepartment of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Nuffield Departments of Clinical Neurosciences and Surgical Sciences, University of Oxford, Oxford, UK.
Yan-Lin LiDepartment of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Nuffield Departments of Clinical Neurosciences and Surgical Sciences, University of Oxford, Oxford, UK.
Muhammed Amir EssibayiDepartment of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 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 GhozyNuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC Program), University of Oxford, Oxford, UK.
Luca ScarciaDepartment of Neuroradiology, Henri Mondor Hospital, Creteil, France.
Leonard L YeoDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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.
Aymeric RouchaudNeuroradiology Department, Dupuytren, Université de Limoges, University Hospital of 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 Kliniken, Lübeck GmbH, Lübeck, Germany.
Marco ColasurdoDepartment of Interventional Radiology, Oregon Health and Science University, 97239, Portland, OR, USA.
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 AbdalkaderDepartments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
Piers KleinDepartments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
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), North State St, Suite 3300, 1200, Los Angeles, CA, USA.
Kareem El NaamaniDepartment of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, 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, GRC BioFast, Sorbonne University, Paris VI, Paris, France.
James E SieglerCooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
Thanh N NguyenDepartments 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.
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, 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.
Constantin HeckerDepartments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.
Gaultier MarnatInterventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
Hamza ShaikhCooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
Christoph J GriessenauerDepartments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.
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, Roma, Italy.
Andrea M AlexandreUOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Roma, Italy.
Tobias D FaizyDepartment of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany.
Illario TancrediDepartment of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
Erwah KalsoumDepartment of Neuroradiology, Henri Mondor Hospital, Creteil, France.
Boris LubiczDepartment of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Vitor Mendes PereiraNeurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
Aman B PatelNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Maurizio FuschiDepartment of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Nuffield Departments of Clinical Neurosciences and Surgical Sciences, University of Oxford, Oxford, UK.
Max WintermarkDepartment of Neuroradiology, MD Anderson Medical Center, 77030, Houston, TX, USA.
Jeremy J HeitDepartment of Interventional Neuroradiology, Stanford Medical Center, Stanford Palo Alto, CA, USA.
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.
MAD MT Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) for distal, medium vessel occlusions (DMVO) is not well established. This study investigates whether IVT impacts outcomes in DMVO patients, particularly in those with unsuccessful or partial recanalization after MT.

methodsWe conducted a retrospective, multicenter study using data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. The study population included AIS patients with DMVO in the M2, M3, and M4 segments of the MCA, treated with or without IVT followed by MT and a final modified Thrombolysis in Cerebral Infarction (mTICI) score of 0, 1, or 2a. The primary outcome was functional independence, assessed by the 90-day modified Rankin Scale (mRS) of 0-1 or 0-2.

resultsThe study comprised 210 patients with final mTICI 0 to 2a, with 130 undergoing MT alone and 80 receiving IVT followed by MT. Logistic regression analysis revealed no significant differences in clinical outcomes between groups. The odds ratios (ORs) for achieving a 90-day mRS of 0-1 and 0-2 were 1.55 (95% CI 0.62 to 3.87; p = 0.34) and 1.55 (95% CI 0.72 to 3.37; p = 0.26), respectively. The odds of symptomatic intracerebral hemorrhage (sICH) were similar between groups (OR 0.64, 95% CI 0.28 to 1.47; p = 0.29), as were the odds of intracranial hemorrhage (ICH) of any type (OR 1.39, 95% CI 0.71 to 2.73; p = 0.34).

conclusionsIn AIS patients with DMVO and unsuccessful or partial recanalization after MT, IVT did not significantly improve clinical outcomes. Additionally, IVT did not increase the risk of hemorrhagic complications. These findings suggest that while IVT preceding MT is safe in this context, it may not improve outcomes for patients with unsuccessful MT.

Indexed as

Fibrinolytic AgentsInfarction, Middle Cerebral ArteryThrombectomyThrombolytic TherapyAgedFemaleHumansMaleMiddle AgedRegistriesRetrospective StudiesTreatment OutcomeFibrinolytic AgentsAcute Ischemic StrokeDistal Medium Vessel OcclusionIntravenous ThrombolysisMechanical ThrombectomyMiddle Cerebral ArteryModified Rankin Scale

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