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Background <p>Optimal treatment for acute ischemic stroke due to distal medium-vessel occlusion (DMVO) in the middle cerebral artery (MCA) remains uncertain. While mechanical thrombectomy (MT) may pose higher risks in DMVO, intra-arterial thrombolysis (IAT)—with or without intravenous thrombolysis (IVT)—could be a&#xa0;safer alternative.</p> Purpose <p>To compare functional outcomes and safety profiles of IAT versus MT in acute ischemic stroke caused by MCA DMVO (M2–M4 segments).</p> Methods <p>We performed a&#xa0;retrospective, propensity score-matched study across 37&#xa0;centers (Asia, Europe, North America) using the MAD-MT registry. Patients with MCA DMVO (M2–M4) treated with IAT or MT (with/without IVT) were included. Propensity score matching adjusted for confounders. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0–1 at 90&#xa0;days).</p> Results <p>After matching, 184 patients were analyzed (19&#xa0;IAT, 165&#xa0;MT). Baseline characteristics were balanced. At 90&#xa0;days, excellent functional outcomes occurred in 38% (IAT) versus 21% (MT) (<i>P</i> = 0.20). Functional independence (mRS&#xa0;0–2) rates were 50% (IAT) versus 40% (MT) (<i>P</i> = 0.42). Mortality was comparable (13% vs. 17%). Successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI]&#xa0;2b–3) was higher with MT (90% vs. 68%; <i>P</i> = 0.02), but symptomatic intracranial hemorrhage occurred only with MT (6.7% vs. 0%; <i>P</i> = 0.60).</p> Conclusion <p>For MCA DMVO, IAT showed similar functional outcomes and numerically fewer safety events than MT despite lower recanalization rates. These findings should be interpreted cautiously, given the small IAT sample size and require validation in larger prospective studies.</p>

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Intra-Arterial Thrombolytic vs. Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Acute Ischemic Stroke: A Preliminary Multinational Multicenter Propensity Score-Matched Study

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  • 发表日期：

    2026年4月20日

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  • Hamza Adel Salim,
  • Benjamin Pulli,
  • Vivek Yedavalli,
  • Takahiro Ota,
  • Dhairya Lakhani,
  • Orabi Hajjeh,
  • Basel Musmar,
  • Nimer Adeeb,
  • Fathi Milhem,
  • Tobias D. Faizy,
  • Kareem El Naamani,
  • Nils Henninger,
  • Sri Hari Sundararajan,
  • Anna Luisa Kühn,
  • Jane Khalife,
  • Sherief Ghozy,
  • Luca Scarcia,
  • Leonard L.L. Yeo,
  • Benjamin Y.Q. Tan,
  • Robert W. Regenhardt,
  • Jeremy J. Heit,
  • Nicole M. Cancelliere,
  • Aymeric Rouchaud,
  • Jens Fiehler,
  • Sunil Sheth,
  • Ajit S. Puri,
  • Christian Dyzmann,
  • Marco Colasurdo,
  • Leonardo Renieri,
  • João Pedro Filipe,
  • Pablo Harker,
  • Răzvan Alexandru Radu,
  • Mohamad Abdalkader,
  • Piers Klein,
  • Thomas R. Marotta,
  • Julian Spears,
  • Ashkan Mowla,
  • Pascal Jabbour,
  • Arundhati Biswas,
  • Frédéric Clarençon,
  • James E. Siegler,
  • Thanh N. Nguyen,
  • Ricardo Varela,
  • Amanda Baker,
  • Muhammed Amir Essibayi,
  • David Altschul,
  • Nestor R. Gonzalez,
  • Markus A. Möhlenbruch,
  • Vincent Costalat,
  • Benjamin Gory,
  • Christian Paul Stracke,
  • Constantin Hecker,
  • Gaultier Marnat,
  • Hamza Shaikh,
  • Christoph J. Griessenauer,
  • David S. Liebeskind,
  • Alessandro Pedicelli,
  • Andrea M. Alexandre,
  • Illario Tancredi,
  • Erwah Kalsoum,
  • Boris Lubicz,
  • Aman B. Patel,
  • Vitor Mendes Pereira,
  • Max Wintermark,
  • Adrien Guenego,
  • Adam A. Dmytriw

摘要

Background

Optimal treatment for acute ischemic stroke due to distal medium-vessel occlusion (DMVO) in the middle cerebral artery (MCA) remains uncertain. While mechanical thrombectomy (MT) may pose higher risks in DMVO, intra-arterial thrombolysis (IAT)—with or without intravenous thrombolysis (IVT)—could be a safer alternative.

Purpose

To compare functional outcomes and safety profiles of IAT versus MT in acute ischemic stroke caused by MCA DMVO (M2–M4 segments).

Methods

We performed a retrospective, propensity score-matched study across 37 centers (Asia, Europe, North America) using the MAD-MT registry. Patients with MCA DMVO (M2–M4) treated with IAT or MT (with/without IVT) were included. Propensity score matching adjusted for confounders. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0–1 at 90 days).

Results

After matching, 184 patients were analyzed (19 IAT, 165 MT). Baseline characteristics were balanced. At 90 days, excellent functional outcomes occurred in 38% (IAT) versus 21% (MT) (P = 0.20). Functional independence (mRS 0–2) rates were 50% (IAT) versus 40% (MT) (P = 0.42). Mortality was comparable (13% vs. 17%). Successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] 2b–3) was higher with MT (90% vs. 68%; P = 0.02), but symptomatic intracranial hemorrhage occurred only with MT (6.7% vs. 0%; P = 0.60).

Conclusion

For MCA DMVO, IAT showed similar functional outcomes and numerically fewer safety events than MT despite lower recanalization rates. These findings should be interpreted cautiously, given the small IAT sample size and require validation in larger prospective studies.