Deans' stroke musings: Endovascular Versus Medical Management in Distal Medium Vessel Occlusion Stroke: The DUSK Study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, May 26, 2024

Endovascular Versus Medical Management in Distal Medium Vessel Occlusion Stroke: The DUSK Study

There's something here but since understandable English was not used; no clue. If we had survivors in charge, we would require readability of all parts of stroke research for survivor understanding. Not this writing for other researchers!

What is the meaning of clinical equipoise?

Clinical equipoise is the assumption that there is not one 'better' intervention present (for either the control or experimental group) during the design of a randomized controlled trial (RCT).

Endovascular Versus Medical Management in Distal Medium Vessel Occlusion Stroke: The DUSK Study

Mahmoud H. Mohammaden,

Lorena Souza Viana,

Hend Abdelhamid,

Marta Olive-Gadea,

Marc Rodrigo-Gisbert,

Originally published24 May 2024https://doi.org/10.1161/STROKEAHA.123.045228Stroke. 2024;55:1489–1497

Abstract

BACKGROUND:

Endovascular treatment (EVT) is part of the usual care for proximal vessel occlusion strokes. However, the safety and effectiveness of EVT for distal medium vessel occlusions remain unclear. We sought to compare the clinical outcomes of EVT to medical management (MM) for isolated distal medium vessel occlusions.

METHODS:

This is a retrospective analysis of prospectively collected data from seven comprehensive stroke centers. Patients were included if they had isolated distal medium vessel occlusion strokes due to middle cerebral artery M3/M4, anterior cerebral artery A2/A3, or posterior cerebral artery P1/P2 segments. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included 90-day good (mRS score, 0–2) and excellent (mRS score, 0–1) outcomes. Safety measures included symptomatic intracranial hemorrhage and 90-day mortality.

RESULTS:

A total of 321 patients were included in the analysis (EVT, 179; MM, 142; 40.8% treated with intravenous thrombolysis). In the inverse probability of treatment weighting model, there were no significant differences between EVT and MM in terms of the overall degree of disability (mRS ordinal shift; adjusted odds ratio [aOR], 1.25 [95% CI, 0.95–1.64]; P=0.110), rates of good (mRS score, 0–2; aOR, 1.32 [95% CI, 0.97–1.80]; P=0.075) and excellent (aOR, 1.32 [95% CI, 0.94–1.85]; P=0.098) outcomes, or mortality (aOR, 1.20 [95% CI, 0.78–1.85]; P=0.395) at 90 days. The multivariable regression model showed similar findings. Moreover, there was no difference between EVT and MM in rates of symptomatic intracranial hemorrhage in the multivariable regression model (aOR, 0.57 [95% CI, 0.21–1.58]; P=0.277), but the inverse probability of treatment weighting model showed a lower likelihood of symptomatic intracranial hemorrhage (aOR, 0.46 [95% CI, 0.24–0.85]; P=0.013) in the EVT group.

CONCLUSIONS:

This multicenter study failed to demonstrate any significant outcome differences among patients with isolated distal medium vessel occlusions treated with EVT versus MM. These findings reinforce clinical equipoise. Randomized clinical trials are ongoing and will provide more definite evidence.