TY - JOUR
T1 - Real-World outcomes of thrombectomy for distal medium vessel occlusions in the middle East and North Africa region
T2 - A multicenter registry analysis
AU - Mansour, Ossama Yassin
AU - Ozdemir, Atilla Ozcan
AU - Gurkas, Erdem
AU - Hassan, Tamer
AU - Aladham, Farid
AU - Alnaami, Ibrahim
AU - Al-Jehani, Hosam Maher
AU - Alshamy, Abdulrahman
AU - Alghamdi, Faisal
AU - Aykac, Ozlem
AU - Elwia, Mohamed Khaled
AU - Hamadani, Hany
AU - Javad, Asim
AU - Galal, Mahmoud
AU - Ghorbani, Mohamed
AU - Hammami, Nadia
AU - Alaa, Mohamed Habib
AU - Hassan, Farouk
AU - Hussain, Syed I.
AU - Imam, Yahia
AU - John, Seby
AU - Ossama, Ahmed
AU - El Khamlichi, Amina
AU - Mahmoud, Amr
AU - Mahmoud, Mostafa
AU - Nasr, Nada
AU - Rashid, Umair
AU - Said, Salma
AU - Saied, Abdulmonem
AU - Wasay, Mohammed
AU - Eldeen, Hany Zaki
AU - Shuaib, Ashfaq
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.
PY - 2025/12
Y1 - 2025/12
N2 - Purpose: Recent randomized trials showed neutral results for distal medium vessel occlusion (DMVO) thrombectomy, but real-world effectiveness across diverse healthcare settings remains unknown. We evaluated DMVO thrombectomy outcomes in the Middle East and North Africa (MENA) region. Methods: The MEMENTO registry retrospectively analyzed consecutive DMVO thrombectomy patients (M2, M3, A2-3, P2-3 segments) across 15 centers (2022–2024). DMVOs were classified as primary, baseline secondary, or iatrogenic secondary. Primary outcome was 90-day functional independence (mRS 0–2). Secondary outcomes included successful recanalization (TICI ≥ 2b), mortality, and symptomatic hemorrhage. Results: Among 164 patients (median age 72, NIHSS 10), subtypes included primary (25%), baseline secondary (50%), and iatrogenic secondary (25%) DMVOs. Overall successful recanalization was 69%, with primary DMVOs achieving higher rates than baseline secondary (78% vs. 59%, p = 0.046). Good functional outcome occurred in 54% overall, with no significant differences between subtypes (primary 59%, baseline secondary 51%, iatrogenic secondary 54%, p = 0.661). Stent retriever achieved highest recanalization (85%) followed by combination (74%) and aspiration (45%, p = 0.046). Independent predictors of poor outcome included age > 75 (aOR 2.34, 95% CI 1.18–4.64), NIHSS > 15 (aOR 3.12, 95% CI 1.45–6.71), and unsuccessful recanalization (aOR 4.89, 95% CI 2.31–10.35). Cost-effectiveness analysis across MENA income levels yielded ICERs of $26,875-$71,333/QALY, exceeding regional GDP thresholds. The modest numerical difference in outcomes (54% vs. 45% historical controls) does not establish clinical benefit given neutral randomized trial results. Conclusions: Real-world DMVO thrombectomy outcomes closely mirror recent randomized trial results showing limited clinical benefit compared to medical management across diverse healthcare settings, with prohibitive economic costs that challenge routine implementation. These findings support highly selective application focusing on younger patients with moderate deficits and primary occlusions.
AB - Purpose: Recent randomized trials showed neutral results for distal medium vessel occlusion (DMVO) thrombectomy, but real-world effectiveness across diverse healthcare settings remains unknown. We evaluated DMVO thrombectomy outcomes in the Middle East and North Africa (MENA) region. Methods: The MEMENTO registry retrospectively analyzed consecutive DMVO thrombectomy patients (M2, M3, A2-3, P2-3 segments) across 15 centers (2022–2024). DMVOs were classified as primary, baseline secondary, or iatrogenic secondary. Primary outcome was 90-day functional independence (mRS 0–2). Secondary outcomes included successful recanalization (TICI ≥ 2b), mortality, and symptomatic hemorrhage. Results: Among 164 patients (median age 72, NIHSS 10), subtypes included primary (25%), baseline secondary (50%), and iatrogenic secondary (25%) DMVOs. Overall successful recanalization was 69%, with primary DMVOs achieving higher rates than baseline secondary (78% vs. 59%, p = 0.046). Good functional outcome occurred in 54% overall, with no significant differences between subtypes (primary 59%, baseline secondary 51%, iatrogenic secondary 54%, p = 0.661). Stent retriever achieved highest recanalization (85%) followed by combination (74%) and aspiration (45%, p = 0.046). Independent predictors of poor outcome included age > 75 (aOR 2.34, 95% CI 1.18–4.64), NIHSS > 15 (aOR 3.12, 95% CI 1.45–6.71), and unsuccessful recanalization (aOR 4.89, 95% CI 2.31–10.35). Cost-effectiveness analysis across MENA income levels yielded ICERs of $26,875-$71,333/QALY, exceeding regional GDP thresholds. The modest numerical difference in outcomes (54% vs. 45% historical controls) does not establish clinical benefit given neutral randomized trial results. Conclusions: Real-world DMVO thrombectomy outcomes closely mirror recent randomized trial results showing limited clinical benefit compared to medical management across diverse healthcare settings, with prohibitive economic costs that challenge routine implementation. These findings support highly selective application focusing on younger patients with moderate deficits and primary occlusions.
KW - Distal medium vessel occlusion
KW - MENA region
KW - Stroke
KW - Thrombectomy
UR - https://www.scopus.com/pages/publications/105019651325
UR - https://www.scopus.com/inward/citedby.url?scp=105019651325&partnerID=8YFLogxK
U2 - 10.1007/s00234-025-03795-8
DO - 10.1007/s00234-025-03795-8
M3 - Article
AN - SCOPUS:105019651325
SN - 0028-3940
VL - 67
SP - 3363
EP - 3376
JO - Neuroradiology
JF - Neuroradiology
IS - 12
ER -